7.4
Childhood Disorders

For disorders associated with reactive airway disease consider supraglottic airway or natural guarded airway (NGA) instead of an ETT, if indicated. Intubation and airway instrumentation are strongly associated with bronchospasm
For intraoperative bronchospasm see page 260

Secondhand Smoke (SHS) Exposure

Types
- Secondhand smoke
  - Mixture of side stream smoke given off by the smoking material and exhaled mainstream smoke
- Thirdhand smoke
  - Smoke components that have settled on surfaces and can be absorbed through the skin, ingested, or inhaled when they become resuspended dust
Etiology/Risk Factors
- Based on serum cotinine levels, 37.9% of children aged 3–11 years in the US are exposed to SHS [15]
- Low socioeconomic status
Pathophysiology
- ↑ Frequency of respiratory symptoms
- ↑ Risk and severity of asthma and wheezing
- ↑ Caries rate in primary teeth [16]
Treatment
- Counsel parents on creating smoke‐free homes and vehicles
- Smoking outside or only when children are not present is less effective
- Limited evidence on passive e‐cigarette “vaping” aerosol exposure
Primary Concerns
- Prone to reactive airway
Evaluation
- History
- Presence of smoke in the preoperative room
Anesthesia Management
- ↑ Risk of reactive airway
- ↑ Risk of intraoperative bronchospasm
- ↑ Risk of excess secretions
- Consider lower threshold for case deferment for patients who have had recent upper respiratory tract infection (URTI) depending on other risk factors
- Keep patient at deeper level of anesthesia to avoid bronchospasm

	1	2	5
Current symptoms	None	Mild Parent confirms URTI Congestion Rhinorrhea Sore throat Low fever Dry cough	Moderate/severe Purulent congestion Wet cough Abnormal lung sounds Lethargy Toxic appearance High fever
Onset	>4 weeks	2–4 weeks	<2 weeks
Lung disease	None	Mild	Moderate/severe
Airway device	None or facemask	Supraglottic airway	Endotracheal tube
Surgery	Other	Minor airway T&A Flexible bronchoscopy Dental	Major airway Cleft repair Rigid bronchoscopy Maxillofacial

Etiology/Risk Factors
- Transmission similar to URTI
- Annual epidemic from November through April in northern hemisphere
- Infects >1 million children annually
- ↑ Risk for morbidity
  - <6 months of age
  - Premature birth
  - Chronic lung disease
  - Congenital heart disease
  - SHS exposure
  - Immunocompromised
Pathophysiology
- Most common cause of lower respiratory tract infection in children
- Associated symptoms
  - URTI
  - Fever
  - OM
  - Bronchiolitis
  - Pneumonia
- Previous infection does not appear to protect from reinfection
Treatment
- Supportive care
- Humidified oxygen
- Inhaled bronchodilators
- May require hospitalization in severe cases
- CDC RSV vaccination recommendations
  - Mothers at 32–36 weeks of pregnancy during RSV season
  - Infants <8 months of age born during RSV season or entering their first RSV season if mother was not vaccinated
  - Some children 8–24 months of age at higher risk
Primary Concerns
- Patients with a history of RSV are more likely to have wheezing later in life
- ↑ Risk of reactive airway
Evaluation
- History
- Physical exam
Anesthesia Management
- Acute illness
  - Delay elective procedure
- Recovering
  - Delay depending on severity and timing of symptoms in conjunction with patient risk factors
  - ↑ Risk of reactive airway
  - ↑ Risk of intraoperative bronchospasm
  - Keep patient at deeper level of anesthesia to avoid bronchospasm

Etiology/Risk Factors
- Most commonly caused by parainfluenza viruses
- Congenital narrowing of the airway
- Hyperreactive airway
- Peak incidence 18 months to 3 years of age
- Fall or early winter
Pathophysiology
- Inflammation of the larynx and subglottic airway (Figure 7.16)
- Barking cough
- Hoarseness
- Inspiratory stridor
- Symptoms last four to six days and are typically worse while lying flat
- Exacerbated by agitation and crying
Treatment
- Humidity
- Hydration
- Fever reduction
- May require hospitalization
  - Inhaled racemic epinephrine
  - Systemic steroids
  - Monitoring for impending respiratory failure
Primary Concerns
- History of frequent croup may predispose to post‐intubation croup
Evaluation
- History
Anesthesia Management
- Acute Illness
  - Delay elective procedure
- Recovering
  - Delay depending on severity and timing of symptoms in conjunction with patient risk factors
  - Consider smaller ETT
  - Ensure appropriate cuff leak
  - Consider longer PACU recovery to monitor for post‐intubation croup symptoms

Etiology/Risk Factors
- Bacterial
- Viral
- Fall and winter months
- Peak incidence 6–12 months of age
Pathophysiology
- Inflammation of the middle ear
- Pain
- Ear rubbing
- Hearing loss
- Drainage
- Fever
- On otoscopy:
  - Red tympanic membrane
  - Immobile
  - Bulging
  - Loss of landmarks
- Typically resolves in ~3 days with or without antibiotics
Treatment
- Oral antibiotics
- May be referred for myringotomy and tube placement after repeated episodes
Primary Concerns
- Tube placement commonly reported on surgical histories
Evaluation
- History
Anesthesia Management
- Active infection considered a contraindication to N₂O
- No current literature on increased perioperative morbidity with patient who has active OM infection

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Oct 16, 2024 | Posted by mrzezo in Oral and Maxillofacial Surgery | Comments Off