You discover that the patient had a recent upper respiratory infection (URI), would you postpone surgery? For how long?
Answer:
Respiratory tract infections are the most common stimuli that trigger acute exacerbations of asthma. Even healthy subjects have transiently increased airway responsiveness to nonspecific stimuli following a viral infection. It is unclear how long surgery should be delayed following a URI because airway hyperreactivity can last 2 to 8 weeks after the infection in both healthy subjects and patients with asthma. Cohen and Cameron reported that a child with a URI having endotracheal anesthesia has an 11-fold increased risk of respiratory complications. In addition, Tait and Knight found that laryngospasm and bronchospasm were significantly increased in healthy children 2 weeks after a URI. However, the data are controversial. A frequently cited retrospective study by Warner et al. found no increase in intraoperative bronchospasm in patients with well-controlled asthma and a recent URI.
In this patient presenting for elective surgery with multiple risk factors for PPCs, postponing surgery at least 2 weeks after clinical recovery from the URI is reasonable.
Reference(s):
- Barash PG, Cullen BF, Stoelting RK, et al, eds. Clinical Anesthesia. 8th ed. Philadelphia, PA: Wolters Kluwer; 2017:851.
- Cohen MM, Cameron CB. Should you cancel the operation when a child has an upper respiratory infection?Anesth Analg. 1991;72:282-288.
- Tait AR, Knight PR. Intraoperative respiratory complications in patients with upper respiratory tract infections. Can J Anaesth. 1987;34:300-303.
- Warner DO, Warner MA, Barnes RD, et al. Perioperative respiratory complications in patients with asthma. Anesthesiology. 1996;85:460-467.
- Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103(suppl 1):i57-i65.