J Korean Med Sci.  2023 Dec;38(47):e349. 10.3346/jkms.2023.38.e349.

Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19

• Park JB
• Sohn JY
• Kang P
• Ji SH
• Kim EH
• Lee JH
• Kim JT
• Kim HS
• Jang YE

• KMID: 2548800
• DOI: http://doi.org/10.3346/jkms.2023.38.e349

Abstract

Background
The perianesthetic morbidity, mortality risk and anesthesia-associated risk after preoperative coronavirus disease 2019 (COVID-19) omicron variant in pediatric patients have not been fully demonstrated. We examined the association between preoperative COVID-19 omicron diagnosis and the incidence of overall perioperative adverse events in pediatric patients who received general anesthesia.
Methods
This retrospective study included patients aged < 18 years who received general anesthesia between February 1 and June 10, 2022, in a single tertiary pediatric hospital. They were divided into two groups; patients in a COVID-19 group were matched to patients in a non-COVID-19 group during the omicron-predominant period in Korea. Data on patient characteristics, anesthesia records, post-anesthesia records, COVID-19-related history, symptoms, and mortality were collected. The primary outcomes were the overall perioperative adverse events, including perioperative respiratory adverse events (PRAEs), escalation of care, and mortality.
Results
In total, 992 patients were included in the data analysis (n = 496, COVID-19; n = 496, non-COVID-19) after matching. The overall incidence of perioperative adverse events was significantly higher in the COVID-19 group than in the non-COVID-19 group (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.89–1.94). The difference was significant for PRAEs (OR, 2.00; 95% CI, 1.96–2.02) but not in escalation of care or mortality. The most difference between the two groups was observed in instances of high peak inspiratory pressure ≥ 25 cmH ₂ O during the intraoperative period (OR, 11.0; 95% CI, 10.5–11.4). Compared with the non-COVID-19 group, the risk of overall perioperative adverse events was higher in the COVID-19 group diagnosed 0–2 weeks before anesthesia (OR, 6.5; 95% CI, 2.1–20.4) or symptomatic on the anesthesia day (OR, 6.4; 95% CI, 3.30–12.4).
Conclusion
Pediatric patients with the preoperative COVID-19 omicron variant had increased risk of PRAEs. Patients within 2 weeks after COVID-19 or those with symptoms had a higher risk of PRAEs

Keyword

Children; COVID-19; Desaturation; General Anesthesia; Omicron; Perioperative Respiratory Adverse Event; Upper Respiratory Infection

Figure

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  Fig. 1 Daily pediatric COVID-19 cases, vaccination rate, and proportion of the omicron variant in Korea. Nationwide mass infection occurred from February 1 to May 5, 2022. In this retrospective study, the electronic medical records of pediatric patients who underwent general anesthesia at Seoul National University Hospital from January 1 to June 10, 2023, were reviewed. All-cause mortality data were reviewed on July 26, 2022. When the omicron variant became dominant, accounting for more than half of the total, on January 27, 64.6% and 58.2% of children aged 12–17 years had received the first and second vaccination, respectively. There were no reported cases of vaccination in children aged under 11 years in the same period as the vaccination was limited to children aged ≥ 13 years in the Republic of Korea. In our study period, starting from February 1 to May 5, almost all cases of COVID-19 were confirmed to be due to the omicron variant. Vaccination rates of children aged 12–17 years were reported to be 68.5%, 65.6%, and 9.8% for first, second, and third doses, respectively, on May 31. In children aged 5–11 years, only 1.4% and 0.2% received the first and second vaccination, respectively, and there was no vaccination for children aged under 5 years at the same date. Data on the daily pediatric COVID-10 cases and the vaccination rates in Korea were downloaded from https://ncov.kdca.go.kr/ on December 22, 2022.9 Data on the proportion of omicron variant cases in Korea were downloaded from https://ourworldindata.org/coronavirus on December 22, 2022.10 COVID-19 = coronavirus disease 2019.

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