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Upper Respiratory Infection (URI)

Anesthesia Implications

Anesthesia Implications

Implications of URI are most often pointed at the pediatric population. Peds that present with URI are much more likely to have postoperative transient hypoxemia, hypoxemia, laryngospasm, atelectasis, croup, stridor, and bronchospasm. If the surgery is elective, postponing the surgery should be strongly considered if the pediatric patient exhibits any of the following:

  • Fever
  • Purulent rhinitis
  • Productive cough
  • Rhonchi
In the event that a surgery is to be delayed, 6 weeks from symptom onset is the time necessary for airway reactivity to resolve. Airway reactivity is not the only reason to postpone surgery. General anesthesia may actually contribute to worsening the infection; Namely, a combination of reduced tracheomucocilliary flow, reduced pulmonary bactericidal activity, and positive pressure ventilation which can force the infection into the lower airway. In any case, consult with the physician to determine the urgency of the procedure and tailor the patients eligibility based on the array of symptoms

Pathophysiology

Nasopharyngitis is the most common URI. Nasopharyngitis is subdivided into two classes: infectious and non-infectious. Infectious nasopharyngitis is the most common (95%) and can be viral or bacterial. The primary culprits are the respiratory syncytial virus (RSV), coronavirus, influenza virus, rhinovirus, and parainfluenza virus. non-infectious nasopharyngitis can be a result of vasomotor problems or allergies. Symptoms are most commonly rhinorrhea, a non-productive cough, and sneezing. Fever, productive cough, and malaise indicate an infective URI.

Reference

Hines. Stoelting’s anesthesia and co-existing disease. 7th edition. 2018.p. 15
Nagelhout. Nurse anesthesia. 5th edition. 2014.p. 363