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British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 6, Issue.: 11

Original-research-article

Association between Intraoperative and Post-Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand

 

Maliwan Oofuvong1*, F. Alan Geater2, Virasakdi Chongsuvivatwong2, Ngamjit Pattaravit1 and Kanjana Nuanjun1

1Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.

Article Information
Editor(s):
(1) Jimmy T. Efird, Department of Public Health, Epidemiology and Outcomes Research East Carolina Heart Institute, Brody School of Medicine, USA.
Reviewers:
(1) Clover-Ann Lee, Department of Anaesthesia, University of the Witwatersrand, Johannesburg, South Africa.
(2) Kotie Bester, Department of Anaesthesia, University of Cape Town (Red Cross War Memorial Children’s Hospital and Groote Schuur Hospital), South Africa.
(3) Somchai Amornyotin, Department of Anesthesiology and Siriraj GI Endoscopy Center, Mahidol University, Thailand.
Complete Peer review History: http://www.sciencedomain.org/review-history/7921

Abstracts

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand.
Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI).
Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9).
Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

Keywords :

Intraoperative period; post-anesthetic care unit; respiratory events; pediatric anesthesia; tertiary care hospital.

Full Article - PDF    Page 1101-1112

DOI : 10.9734/BJMMR/2015/15789

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