Pediatric Anesthesia Techniques during the COVID-19 Pandemic

The pediatric population is a contagion fuel for SARS CoV-2, putting health care workers at risk. Exposure to respiratory droplets and aerosols are a major cause of disease transmission during airway procedures. Crying, coughing, laryngospasm, airway obstruction and hypoxia, which are more frequent in children than adults, directly or indirectly increase aerosol production and hence the risk of transmission to health workers. We present recommendations for the perioperative management of children suspected or confirmed positive for COVID-19, with the aim of reducing the risk of infection in these patients and in the healthcare team.

COVID-19, Pediatric anesthesia, SARS CoV-2, Aerosol box, Airway

[1] Marraro GA, Spada C. Consideration of the respiratory support strategy of severe acute respiratory failure caused by SARS-CoV-2 infection in children. Zhongguo Dang Dai Er Ke Za Zhi. 2020;22:183–194.

[2] Calvo C, García López-Hortelano M, de Carlos Vicente JC, et al. Recommendations on the clinical management of the COVID-19 infection by the «new coronavirus» SARS-CoV2. Spanish Paediatric Association working group. An Pediatr (Barc). 2020;92:241.e1-241.e11.

[3] Lee-Archer P, Ungern-Sternberg BS. Pediatric anesthetic implications of COVID-19-A review of current literature. Pediatr Anesth. 2020.

[4] Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;16:240-246.

[5] Cao Q, Chen Y-C, Chen C-L, et al. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119:670–673.

[6] Castagnoli R, Votto M, Licari A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020.

[7] Carl Heneghan, Jason Oke, Tom Jefferson. COVID-19 How many Healthcare workers are infected? CEBM. 2020. Available from: https://www.cebm.net/covid-19/covid-19-how-many-healthcare-workers-are-infected/.

[8] Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088-1095.

[9] COVID-19 en personal de salud en Colombia, Boletín No.6. Instituto Nacional de Salud de Colombia. 2020. Available in: https://www.ins.gov.co/COVID19PERSONALDESALUDCOLOMBIA/boletin-6-covid-personal-salud.jpg.

[10] Public Health England. COVID-19: infection prevention and control guidance. Available from: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe.

[11] Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382:1564-1567.

[12] Wen X, Li Y. Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19. Surg Infect (Larchmt). 2020;21:299–299.

[13] Cook TM. Personal protective equipment during the COVID-19 pan-demic - a narrative review. Anaesthesia. 2020;75:920-927.

[14] World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. 2020. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations.

[15] Yang Y-L, Huang C-H, Luk H-N, et al. Adaptation to the Plastic Barrier Sheet to Facilitate Intubation during the COVID-19 Pandemic. Anesth Analg. 2020.

[16] Schrock CR, Montana MC. Rapid COVID-19–related Clinical Adapta-tions and Unanticipated Risks. Anesthesiology. 2020;133:248.

[17] Trujillo A, Jaramillo X. Considerations for the Use of Respiratory Filters in Children During the COVID-19 Pandemic. Surg Infect (Larchmt). 2020.

[18] Rosenbaum A, Kain ZN, Laisson P, et al. The place of premedication in pediatric practice. Pediatr Anesth. 2009;19:817–828.

[19] Consenso recomendaciones anestesia pediatrica sección anestesia pediatrica. SEDAR. 2020. Available in: https://www.sedar.es/images/site/NOTICIAS/coronavirus/2020_Ped_Covid19_ recomendaciones_final.pdf.

[20] Von Ungern-Sternberg BS, Salbutamol premedication in children with a recent respiratory tract infection. Paediatr Anaesth. 2009;19:1064–1069.

[21] Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth. 2020;67:568-576.

[22] Ballard A, Khadra C, Adler S, et al. External cold and vibration for pain management of children undergoing needle- related procedures in the emergency department: a randomised controlled non-inferiority trial protocol. BMJ Open. 2019;9:e023214.

[23] Ballard A, Khadra C, Adler S, et al. Efficacy of the Buzzy Device for Pain Management During Needle-related Procedures. Clin J Pain. 2019;35:532–543.

[24] Else SDN, Kovatsis PG. A Narrative Review of Oxygenation During Pe-diatric Intubation and Airway Procedures. Anesth Analg. 2020;130:831–840.

[25] Abdelgadir IS, Phillips RS, Singh D, et al. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev. 2017;5:CD011413.

[26] Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev. 2013;2013:CD003844.

[27] Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-1308.

[28] Meng L, Qiu H, Wan L, et al. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience. Anesthesiology. 2020;132; 1317-1332.

[29] Amato MBP, Meade MO, Slutsky AS, et al. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med. 2015;372:747–755.

[30] Lee JH, Bae J il, Jang YE, et al. Lung protective ventilation during pulmonary resection in children: a prospective, single-centre, randomised controlled trial. Br J Anaesth. 2019;122:692–701.

[31] Jauncey-Cooke J, East CE, Bogossian F. Paediatric lung recruitment: A review of the clinical evidence. Paediatr Respir Rev. 2015;16:127–132.

[32] Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19). Can J Anesth. 2020;67;759.

[33] Trujillo A. Response to Wen and Li, Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19. Surg Infect (Larchmt). 2020;21:398.

[34] Koo C-H, Lee S, Chung S, et al. Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis. J Clin Med. 2018;7:353.

[35] Jung H, Kim HJ, Lee Y-C, et al. Comparison of lateral and supine positions for tracheal extubation in children. Anaesthesist. 2019;68:303–308.

[36] Inomata S, Suwa T, Toyooka H, et al. End-Tidal Sevoflurane Concentra-tion for Tracheal Extubation and Skin Incision in Children. Anesth Analg. 1998;87:1263–12677.

[37] Cranfield KAW, Bromley LM. Minimum alveolar concentration of des-flurane for tracheal extubation in deeply anaesthetized, unpremedicated children. Br J Anaesth. 1997;78:370–371.

[38] Tung A, Fergusson NA, Ng N, et al. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis. Br J Anaesth. 2020;124:480–495.

[39] Bhat S, Sanikop C. Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries. Indian J Anaesth. 2010;54:132.