Viral upper respiratory infection (URI) alters the quality and quantity of airway secretions and increases airway reflexes to mechanical, chemical, or irritant stimulation. Some clinical studies have shown associated intraoperative and postoperative bronchospasm, laryngospasm, and hypoxia. There is evidence that the risk of pulmonary complications may remain high for at least 2 weeks and possibly 6 to 7 weeks after a URI. Infants have a greater risk than older children, and intubation probably confers additional risk.
Young children can average five to eight URIs per year, mostly from fall through spring. If a 4- to 7-week delay for elective surgery were rigorously followed, then elective surgery might be postponed indefinitely. Therefore most anesthesiologists distinguish uncomplicated URI with chronic nasal discharge from nasal discharge associated with more severe URI with or without lower respiratory infection (LRI). Chronic nasal discharge is usually noninfectious in origin and caused by allergy or vasomotor rhinitis. An uncomplicated URI is characterized by sore or scratchy throat, laryngitis, sneezing, rhinorrhea, congestion, malaise, nonproductive cough, and temperature <38° C. More severe URI or LRI may include severe nasopharyngitis, purulent sputum, high fever, deep cough, and associated auscultatory findings of wheezes or rales.
It is generally agreed that chronic nasal discharge poses no significant anesthesia risk. In contrast, elective surgery is almost always postponed in children with severe URI or LRI. Most anesthesiologists will proceed to surgery with a child with a resolving uncomplicated URI unless the child has a history of asthma or other significant pulmonary disease.
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.