URI: Airway Reactivity

Bronchial hyperreactivity may last as long as 6 weeks following an upper respiratory tract infection, of which up to 95% are of viral etiology. In the acute phase both chemical mediators (bradykinin, prostaglandin, histamine, and interleukin) and neurologic reflexes contribute to morphologic and functional changes in the respiratory epithelium. Patients requiring anesthesia during this time are at increased risk of laryngospasm, bronchospasm, coughing, breath holding, postintubation croup, atelectasis, pneumonia, and episodes of desaturation.

It should be noted that the same incidence of airway-associated complications occur in children who are recovering from a URI as for those in the acute phases of infection. Predictors of adverse respiratory events include surgery on the airway, history of reactive airways disease and asthma, passive smoking, snoring, the parents’ statement that the child has a “cold”, presence of copious secretions, and nasal congestion. General anesthesia via mask or laryngeal mask airway is preferable to endotracheal intubation and has may be associated with a lower incidence of intraoperative and postoperative respiratory complications. The incidence of adverse airway-related events is not reduced by the administration of anticholinergic or bronchodilating medications. An algorithm for the assessment and anesthetic management of the child with an upper respiratory infection is presented below.