None listed
Conditions
Brief summary
Despite the development of anaesthesia management guidelines, perioperative respiratory adverse events (PRAE) remain a major cause of morbidity and mortality during paediatric anaesthesia, causing more than three quarters of critical incidents and nearly one third of all perioperative cardiac arrests. In paediatric anaesthesia, obesity is a significant problem with obese children not only having anaesthesia-relevant co-existing diseases like asthma or hypertension, but also having a higher incidence of anaesthesia related complications. Many factors encountered during general anaesthesia such as supine positioning (lying down, face up), anaesthetic agents and the type of surgery affect the functioning of the respiratory system and in particular lung volumes and respiratory mechanics. These anaesthesia related changes in lung function are expected to be even more pronounced in obese patients. The incidence of obesity is rising steadily in Australia with 25% of children being overweight or obese in 2011-2012 according to the Australian Bureau of Statistics. A better knowledge of lung health and the changes in lung function caused by anaesthesia and the impairment of respiratory mechanics by obesity will help improve the management of these high risk patients. We therefore aim to assess lung function changes as well as the incidence of PRAE in healthy and overweight/obese children. We hypothesise that 1.The incidence of PRAE will be higher in obese/overweight children compared to normal weight children. 2.Obese or overweight children will have a significantly different respiratory resistance (Rrs) and reactance (Xrs) compared to normal weight children. 3.The state of consciousness (being awake or anaesthetised) and the body position (being seated or supine) will affect the respiratory resistance and reactance and that this effect with be more pronounced in overweight and obese children compared to children with a healthy weight. We will recruit 110 children between the ages of 6 and 16 that have a BMI between the 5th and 85th percentile for the healthy population (n equal to 55) and more than or equal to the 85th percentile for the obese/overweight population (n equal to 55). Lung function testing consisting of Forced Oscillation Technique (FOT) and Multiple Breath Washout (MBW) will be completed on all patients on the day of their procedure. All patients will be monitored closely during and following their procedures and any respiratory events will be recorded. We are hoping to get a better understanding of the lung health of the obese and overweight population of children in order to improve the anaesthetic management of this high risk group.
Interventions
All participants will be recruited at the preanaesthetic visit and will be consented voluntarily to the study after approval from the consulting anaesthetist.
Children’s weight, height and age will be used to calculate their BMI percentile to assign them to the two study groups:
*Group 1, normal weight: patients aged between 6 and 16 years with a BMI above the 5th percentile and below the 85th percentile
*Group 2, overweight/obese: patients aged between 6 and 16 years with a BMI greater than or
All participants will be recruited at the preanaesthetic visit and will be consented voluntarily to the study after approval from the consulting anaesthetist. Children’s weight, height and age will be used to calculate their BMI percentile to assign them to the two study groups: *Group 1, normal weight: patients aged between 6 and 16 years with a BMI above the 5th percentile and below the 85th percentile *Group 2, overweight/obese: patients aged between 6 and 16 years with a BMI greater than or equal to the 85th percentile. Each patient will complete Lung function testing which will involve two different tests before anaesthesia induction: the measurement of respiratory mechanics using the forced oscillation technique and lung volumes using the multiple breath washout technique. The forced oscilation technique will be repeated after anaesthesia induction. Patients will be monitored throughout their procedures and postoperatively in the post anaesthesia care unit (PACU). Any respiratory complications that may occur will be documented. Patients will be followed up on the ward or via telephone within 3 days following surgery incase of any complications.
Sponsors
Britta Regli Von Ungern Sternberg
Eligibility
Sex/Gender
All
Age
6 Years to 16 Years
Healthy volunteers
Yes
Inclusion criteria
*Children undergoing elective surgery *Male or Female aged between 6 and 16 years *Children with a BMI more than the 5th and less than the 85th percentile (normal weight group) *Children with a BMI more than or equal to 85th percentile (overweight and obese group) *Children having a laryngeal mask airway (LMA).
Exclusion criteria
*Children with a known cardiopulmonary disease: *Uncorrected congenital heart disease *Primary/secondary pulmonary hypertension *Cardiac/thoracic malformations/tumours *Structural lung changes *Airway malformations, thorax deformity *Children unable to perform the lung function tests. *Children receiving a sedating premedication (e.g. midazolam, clonidine) before surgery. *Children having used a bronchodilator within 5 hours prior to surgery. *Children having an endotracheal tube inserted during anaesthesia The above list is not an exhaustive list. Other less common cardiopulmonary conditions will be assessed by the anaesthetist in charge in consulation with the study team.
Outcome results
None listed