[size=20px]You have scheduled a two-year old male for elective inguinal hernia repair and upon arrival to the ambulatory surgery center the patient has a productive cough, runny nose and low grade fever. Your anesthesiologist believes that the child has a moderate to severe upper respiratory tract infection.

 

Based on best evidence, this nonurgent operation should

 

A proceed.

 

B be delayed one week.

 

C be delayed two weeks.

 

D be delayed four weeks.

 

E be delayed six weeks.[/size]

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I'll wait for atleast a week. Will however educate the parents of features of incarceration for urgent surgical consultation.

D

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B and inform the parents red flag signs for incarceration for urgent consultation

D

correct

 

Children with upper respiratory illnesses (URI) who undergo general anesthesia are at increased risk of respiratory complications including laryngospasm, bronchospasm and arterial desaturation. Evidence of systemic illness (e.g. fever, toxic appearance) or lower respiratory tract disease (e.g. productive cough, wheezing) are relative contraindications for elective anesthetics. Research suggests that children with uncomplicated mild URI symptoms can undergo general anesthesia without significant increase in anesthetic complications. Data associating risk of perioperative complications with specific etiologic agents are largely absent from the literature.

 

Children undergoing general anesthesia with occult respiratory syncytial virus (RSV) or influenza infection have an increased risk of unplanned intensive care unit admission and increased length of hospital stay. No difference was found between cases and matched controls related to the risk of perioperative complications, requirements for prolonged positive pressure ventilation or mortality.

 

Most research on this topic suggests that most otherwise uncomplicated patients with mild URI can typically proceed with elective anesthesia. Most recommendations include that for a moderate to severe URI, elective anesthetics should be delayed four weeks and for RSV or lower airway infections the delay should be at least six weeks.