That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia
does this “biologic plausibility” translate into real-world events?
The adult data is limited, and most of the literature on periop URIs comes from the pediatric literature because, well, kids get sick…a lot
❇️No mucopurulent secretions
Here’s one resource:
A 1996 study in Anesthesiology on periop respiratory complications in patients WITH asthma examined a lot of variables, INCLUDING acute/recent URI--recent URI did not increase complications 🤔
How do you assess that?
mantra 1: “this patient, this surgery, this indication, and this time”
and add “this anesthetic technique (ex. General with intubation? LMA? Regional with sedation?)
❓can the surgery be delayed?
❓If you delay, how long should you wait?
❓How long does the airway hyperreactivity last even after symptoms resolve?
🌀nature of the patient?
🌀underlying pulmonary disease?
If so, how severe is the condition, what at the baseline symptoms and degree of control?
🌀timing of onset
🌀Oropharyngeal exam? (edema/tonsillitis)
⏺️Oral decongestants v sympathomimetic effects?
⏺️Antihistamines v post-op sedation?
What would you do in these hypothetical situations?
3 days preop she feels “90% better”. Pulm exam normal.
What if surgery was scheduled during winter break? If it doesn’t happen this week, it won’t happen again until summer break in 6 months??
🔘Healthy adult w acute URI day of surgery➡️delay 1-2 weeks?
🔘Adult with asthma w acute URI➡️delay 1-2 weeks
🔘Healthy adult w recent URI but asymptomatic➡️proceed?
🔘Moderate to severe COPD w acute URI➡️delay elective surgery, recovery may be variable
✅Ask about URI symptoms before surgery, along w
✅severity of symptoms
✅presence/severity of underlying lung disease
✅Don’t automatically cancel surgery JUST because someone has or is recovering from a URI
✅Get your flu vaccine!