Common post-operative complications in children

Dilip Pawar, Dilip Pawar

Abstract

The exact incidence of common post-operative complications in children is not known. Most common one is post-operative nausea and vomiting followed by respiratory complications leading to hypoxia. Cardiac complications are less in children without associated congenital cardiac anomaly. Post-operative shivering, agitation and delirium are seen more often in children anaesthetised with newer inhalational agents like sevoflurane and desflurane. Urinary retention in the post-operative period could be influenced by anaesthetic drugs and regional blocks. The purpose of this article is to review the literature and present to the postgraduate students comprehensive information about the current understanding and practice pattern on various common complications in the post-operative period. Extensive literature was searched with key words of various complications from Pubmed, Google scholar and specific journal, namely paediatric anaesthesia. The relevant articles, review article meta-analysis and editorials were the primary source of information for this article.

Keywords: Antiemetic drugs; apnoea; complications; dexmedetomidine; emergence agitation; emergence delirium; hypoxia; laryngospasm; nausea; paediatric; shivering; vomiting.

Conflict of interest statement

Conflict of Interest: None declared

References

    1. Paterson N, Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011;21:848–57.
    1. Kovac AL. Management of postoperative nausea and vomiting in children. Paediatr Drugs. 2007;9:47–69.
    1. Rawlinson A, Kitchingham N, Hart C, McMahon G, Ong SL, Khanna A. Mechanisms of reducing postoperative pain, nausea and vomiting: A systematic review of current techniques. Evid Based Med. 2012;17:75–80.
    1. Eberhart LH, Geldner G, Kranke P, Morin AM, Schäuffelen A, Treiber H, et al. The development and validation of risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg. 2004;99:1630–37.
    1. Hermans V, De Pooter F, De Groote F, De Hert S, van der Linden P. Effect of dexamethasone on nausea, vomiting, and pain in paediatric tonsillectomy. Br J Anaesth. 2012;109:427–31.
    1. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth. 2003;50:392–7.
    1. de Orange FA, Marques J, Flores M, Borges PS. Dexamethasone versus ondansetron in combination with dexamethasone for the prophylaxis of postoperative vomiting in pediatric outpatients: A double-blind, randomized, placebo-controlled clinical trial. Pediatr Anesth. 2012;22:890–6.
    1. Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: A systematic review and meta-analysis. Br J Anaesth. 2006;97:593–604.
    1. Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Pediatr Anesth. 2004;14:218–24.
    1. Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: Laryngospasm. Qual Saf Health Care. 2005;14:e3.
    1. Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Pediatr Anesth. 2008;18:303–7.
    1. Tsui BC, Wagner A, Cave D, Elliott C, El-Hakim H, Malherbe S. The incidence of laryngospasm with a ‘no touch’ extubation technique after tonsillectomy and adenoidectomy. Anesth Analg. 2004;98:327–9.
    1. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95:299–306.
    1. Pawar D. Perioperative laryngospasm in children. KK Hospital Review. 2009;12:14–7.
    1. Al-alami AA, Zestos MM, Baraka AS. Pediatric laryngospasm: Prevention and treatment. Curr Opin Anaesthesiol. 2009;22:388–95.
    1. Schreiner MS, O’Hara I, Markakis DA, Politis GD. Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? Anesthesiology. 1996;85:475–80.
    1. Flick RP, Wilder RT, Pieper SF, van Koeverden K, Ellison KM, Marienau ME, et al. Risk factors for laryngospasm inchildren during general anesthesia. Pediatr Anesth. 2008;18:289–96.
    1. Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case Scenario: Perianesthetic Management of Laryngospasm in Children. Anesthesiology. 2012;116:458–71.
    1. Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. Pediatr Anesth. 2005;15:1094–7.
    1. Walker RW, Sutton RS. Which port in a storm? Use of suxamethonium without intravenous access for severe laryngospasm. Anaesthesia. 2007;62:757–9.
    1. Bolaji BO, Oyedepo OO, Dunmade AD, Afolabi OA. Negative pressure pulmonary edema following adenoidectomy under general anaesthesia: A case series. West Afr J Med. 2011;30:121–4.
    1. Domnica PJ, Floret D, Bouchut JC. Negative pressure pulmonary edema and airway foreign body retrieval: Anesthetic considerations. Pediatr Anesth. 2010;20:288–9.
    1. Thiagarajan RR, Laussen PC. Negative pressure pulmonary edema in children-pathogenesis and clinical management. Pediatr Anesth. 2007;17:307–10.
    1. Malviya S, Swartz J, Lerman J. Are all preterm infants younger than 60 weeks postconceptual age at risk for postanesthetic apnea? Anesthesiology. 1993;78:1076–81.
    1. Henderson-Smart DJ, Steer P. Postoperative caffeine for preventing apnea in preterm infants. Cochrane Database Syst Rev. 2000;2:CD000048.
    1. Thong SY, Lim SL, Ng AS. Retrospective review of ilioinguinal-iliohypogastric nerve block with general anesthesia for herniotomy in ex-premature neonates. Pediatr Anesth. 2011;21:1109–13.
    1. Brown KA. Outcome, risk, and error and the child with obstructive sleep apnea. Pediatr Anesth. 2011;21:771–80.
    1. Schnoor J, Ilgner J, Merkenschlager A. Obstructive sleep apnea in childhood: Anesthesiological aspects. Anaesthesist. 2012;61:69–78.
    1. Hessén Söderman AC, Ericsson E, Hemlin C, Hultcrantz E, Månsson I, Roos K, et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: Results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope. 2011;121:2322–6.
    1. Akin A, Esmaoglu A, Boyac A. Postoperative shivering in children and causative factors. Pediatr Anesth. 2005;15:1089–93.
    1. Easley RB, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Pediatr Anesth. 2007;17:341–6.
    1. Malarbi S, Stargatt R, Howard K, Davidson A. Characterizing the behavior of children emerging with delirium from general anesthesia. Pediatr Anesth. 2011;21:942–50.
    1. Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997;87:1298–300.
    1. Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Rapid emergence does not explain agitation following sevofluraneanaesthesia in infants and children: A comparison with propofol. Pediatr Anesth. 2003;13:63–7.
    1. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevofluraneanaesthesia and no surgery: A comparison with halothane. Pediatr Anesth. 2000;10:419–24.
    1. Chen J, Li W, Hu X, Wang D. Emergence agitation after cataract surgery in children: A comparison of midazolam, propofol and ketamine. Pediatr Anesth. 2010;20:873–9.
    1. Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Oral ketamine premedication can prevent emergence agitation in children after desfluraneanaesthesia. Pediatr Anesth. 2004;14:477–82.
    1. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: Anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–57.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner