None listed
Conditions
Brief summary
Australia has one of the highest rates of asthma and allergy in the world. Both are strong risk factors for perioperative respiratory adverse events (PRAE), which are the leading cause of critical incidents in paediatric anaesthesia It is already well established that the severity of current asthma, as well as the effect of therapeutic asthma drugs, can be assessed by monitoring exhaled nitric oxide levels. In addition, exhaled nitric oxide levels can be easily measured in children using a simple non-invasive device. The aim of this study is to assess whether the measurement of exhaled nitric oxide levels may be used to identify children at a particularly high risk for respiratory complications. By identifying this at risk group, the anaesthetist will be able to make a more informed decision regarding the optimal time for surgery, as well as institute the appropriate medical management prior to surgery for each individual child. Optimising the anaesthesia management for this high-risk group would be expected to lead to a reduction in perioperative respiratory complications. Since respiratory complications are one of the leading causes for morbidity and mortality in paediatric anaesthesia, such a reduction would lead to a major improvement in outcomes for high-risk children undergoing anaesthesia. In addition to an anticipated reduction in the occurrence of respiratory complications, this study has the potential to reduce the health costs associated with the occurrence of these complications (e.g. unplanned hospital admissions, prolonged hospital stay, additional treatment). We also anticipate that our findings will lead to an improvement in waiting list times, aid the scheduling of surgery, assist in the preoperative identification of children at a higher risk of PRAE and aid the planning of appropriate preventive strategies, thereby reducing the cancellation of surgery. Cancellations have associated adverse economic impacts for the health care system, cause enormous emotional and financial burdens for the child and his/her family as well as engender lack of confidence in the public health care system. To conclude, we anticipate that this study will improve the safety of children undergoing anaesthesia by providing early detection of high-risk patients which will aid the optimal timing of surgery, enhance the anaesthesia management of our patients, help reduce the costs of prolonged hospital stay associated with peroperative complications and optimise waitlist times. Further benefits may include a reduced requirement for critical care facilities, a decrease in unexpected intensive care admissions and enhanced child/parent satisfaction rates.
Interventions
non invasive measurement of exhaled NO preoperatively with the aid of a Niox Mino (Aerocrine, Sweden). The child has to exhale into a mouthpiece attached to the Niox Mino. Only one measurement will be taken at the preoperative assessment. In childen < 130cm height, the measurement takes 6s, while the NO measurement in children of 130cm or taller the measurement takes 10 s.
The patient will be monitores for respiratory adverse events throughout the perioperative period until the patient is discha
non invasive measurement of exhaled NO preoperatively with the aid of a Niox Mino (Aerocrine, Sweden). The child has to exhale into a mouthpiece attached to the Niox Mino. Only one measurement will be taken at the preoperative assessment. In childen < 130cm height, the measurement takes 6s, while the NO measurement in children of 130cm or taller the measurement takes 10 s. The patient will be monitores for respiratory adverse events throughout the perioperative period until the patient is discharged from the post anaesthesia care unit.
Sponsors
Department of Anaesthesia and Pain Management
Eligibility
Sex/Gender
All
Age
4 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
Children, aged 4 to 16 years, male or female undergoing elective minor surgery 100 healthy children with no risk factors 180 children with 2 or more risk factors for developing PRAE: -cold or flu currently or in the last 2 weeks -eczema at present or in the past -wheezing in the last 12 months -asthma in the past (if wheezing in the last 12 months is negative) -dry nocturnal cough -wheezing at exercise -family history of asthma (mother, father and/or siblings) -family history of eczema (mother, father and/or siblings) -family history of hay fever (mother, father and/or siblings) -passive smoking (mother, father, caregiver)
Exclusion criteria
Children with airway malformations Pre-medication of Midazolam Children with Neurological imparement Children with Cardiac Disease Children who are uncooperative
Outcome results
None listed