Feasibility and efficacy of using lung measurements to predict complications during surgery for young children with and without asthma.

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Each year over 10 000 children attend Princess Margaret Hospital for Children (PMH) to have surgery under general anaesthesia, with many more children attending other hospitals at a state and national level. Respiratory complications are the most frequent problem under general anaesthesia, particularly in young children. Over one quarter of children visiting PMH for surgery have asthma or related breathing difficulties. These complications may have an impact on surgical outcomes, may lead to delays and cancelled surgeries as well as unplanned admissions to specialised wards. These respiratory complications can be minimised if children at risk are correctly identified preoperatively. Currently, anaesthetists rely on clinical histories to assess this risk. Symptoms such as asthma, wheezing, hay fever and a family history of allergies and asthma amongst others are all associated with a higher risk of respiratory complications under general anaesthesia. Over a series of studies, we have observed that children with active respiratory symptoms such as current asthma, wheeze or persistent dry nocturnal cough experience significantly more respiratory complications compared to children with other known risk factors (such as family history of asthma) or no risk factors. Our data suggests that these children have increased airway inflammation and lower lung function; in a previous study, we observed that 7 out of 10 children with active respiratory symptoms who had airway inflammation experienced respiratory complications during surgery. The use of new screening techniques that allow assessment of the risk for respiratory complications by measuring airway inflammation and changes in lung function would help anaesthetists to better assess this risk. This would then allow the anaesthetist to tailor a personalised anaesthesia management to minimise the risk for these complications. This pilot study aims to assess the feasibility of an innovative personalised approach, easily applicable to young children to significantly improve the prediction of respiratory complications prior to surgery. Males and females aged 4 to 10 years of age will be recruited after voluntary informed consent and will complete two tests prior to their surgery. Tests include measuring airway inflammation using the exhaled nitric oxide test and measuring lung mechanics using the forced oscillation technique. Strong evidence of successful use of these screening techniques will pave the way to dramatically change surgical and anaesthetic risk management prior to surgery and lead to improved health outcomes for children, their families and the broader health-care system.

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