1. URI AND ANAESTHESIA DR.S.SUBBIAH., MNAMS., DA., MD., DCH., SENIOR CONSULTANT IN ANAESTHESIOLOGY, APOLLO SPECIALITY HOSPITALS, MADURAI, FORMER PROFESSOR AND HEAD DEAPRTMENT OF ANAESTHESIOLOGY, MADURAI MEDICAL COLLEGE, MADURAI

2. CONTROVERSIES McGill – 1979 CHILDREN – 11 COMPLICATIONS EASILY DESATURATED 2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES) POSTOPERATIVE INFECTIONS POSTPONEMENT DUE TO URI POSTPONEMENT DUE TO URI

3. INCIDENCE & CAUSATIVE ORGANISMS 500 MILLION OP, 2 MILLION IP, 8 MILLION DAYS, 2 BILLION $ INCIDENCE MORE FREQUENT IN CHILDREN RHINO, INFLUENZA, PARAINFLUENZA, HERPES TO BE DIFFERENTIATED FROM SERIOUS ILLNESSES

4. PATHOPHYSIOLOGICAL CHANGES INFLAMMATIONOEDEMASECRETIONS AIRWAY HYPERREACTIVITY

5. AIRWAY REACTIVITY & PFT INFLAMMATORY MEDIATORS: BRADYKININ, PROSTAGLANDIN, HISTAMINE, INTERLEUKIN VAGAL AUTONOMIC REFLEX VIRAL NEURAMINIDASE - ↑ AC.CHOLINE – MUSCARINIC RECEPTORS ↓ NEUTRAL ENDOPEPTIDASE - ↑ TACHYCHININS LARYNGO / BRONCHOSPASM – 4 TO 6 WKS – 7-FOLD ↑ WORSENED BY GA – RELIEVED BY IPPV FEV1, FVC, VC ↓ - RESISTANCE ↑

6. RISK FACTORS PARNIS PREDICTORS OF ANAESTHETIC COMPLICATIONS: 1. AIRWAY INSTRUMENT – ETT > LMA > MASK 2. HISTORY OF COLD 3. STRONG SNORING 4. PASSIVE SMOKING 5. INDUCTION – THIO>HALO>SEVO>PROPOFOL 6. SPUTUM 7. NASAL CONGESTION 8. REVERSAL – NO REVERSAL > REVERSAL

7. OTHER RISK FACTORS AGE < 5 YRS / PREMATURITY / H/O REACTIVE AIRWAY DISEASE AIRWAY SURGERIES MALVIYA – OF 1078 CHILDREN 2 PNEUMONIAS 1 STRIDOR in the postop. Period TWO DEATHS REPORTED – EXTUBATION BRONCHOSPASM EXTUBATION BRONCHOSPASM CARDIAC ARREST CARDIAC ARREST

8. ANAESTHETIC MANAGEMENT LIDOCAINE NEBULISATION HYDRATION / HUMIDIFICATION / SUCTIONING HALOTHANE / SEVOFLURANE MILD CASES – AVOID INTUBATION SEVERE SYMPTOMS – POSTPONE FOR 6 WKS EMERGENCY – USE LMA IF ET REQUIRED – ATROPINE, SALBUTAMOL AWAKE EXTUBATION, AVOID DEPRESSANTS

9. COMPLICATIONS COUGH, BREATH HOLDING, STRIDOR SPASM – BRONCHO / LARYNGO POSTOP. PENUMONIA BRADY / TACHY ARRHYTHMIA POSTOP. INFECTIONS

10. Alan Tait’s algorithm: Alan Tait’s algorithm: Surgery urgent Surgery urgent Proceed Yes Yes No ? Infectious aetiology ? Infectious aetiology No No Proceed Proceed Yes Severe Symptoms Yes Yes No or Recent URI Postpone 4 wks Postpone 4 wks General Anaesthesia No Proceed Proceed Yes Risk Factors ? H/O asthma Use of ETT Use of ETT Copious secretions Nasal congestion Parental Smoking Parental Smoking Surgery of airway H/O Prematurity Other Factors Other Factors Need for Experience Travelled far Surgery cancelled prior Risk / Benefit ? Good Proceed ProceedPoor Postpone for 4 wks Postpone for 4 wks Management Avoid ETT Avoid ETT Use LMA Use LMA Pulse Oxymetry Pulse Oxymetry Hydration Hydration Humidification Humidification Anticholinergics Anticholinergics

11. TO SUMMARISE RECOMBINANT NEUTRAL ENDOPEPTIDASE ANTI VIRAL AGENTS SPECIFIC M3 BLOCKER POSTPONEMENT – INDIVIDUALISED KNOWLEDGE OF THE COMPLICATIONS & MANAGEMENT 2000 SURGERIES TO BE CANCELLED TO PREVENT 15 SPASMS

12. "Common sense dictates that a patient with an active but self limited disease not be subject to elective anaesthesia and surgery until resolution of the illness". – Statement by McGill in 1979. “…although anesthesia may not be good treatment for the common cold, might it not be a good way of passing the time till the cold is gone?” - Ellis