All of the following are true concerning perioperative respiratory complications in children EXCEPT:
A. A positive family history (2 members of the family) of eczema, asthma or rhinitis are all risk factors for perioperative respiratory complications.
B. LMA removal under deep anesthesia is associated with a lower incidence of perioperative respiratory events
C. Propofol use for maintanence of anesthesia has a lower incidence of perioperative respiratory complications versus sevoflurane
D. Spraying the vocal cords with lidocaine prior to airway manipulation lowers the incidence of bronchospasm and laryngospasm.
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Answer
Ok, so the answer is D.
All of this information is from the Lancet article [1] in 2010 (dare I say landmark) concerning the predictive risk factors for perioperative respiratory complications in pediatrics. This article has a TON of information in it and you should definitely read it if you haven't already. It is the reason to ask if the the kid has had a GREEN nasal discharge. This article shows that it is a risk factor for complications. It is also the article that suggests the risk of perioperative pulmonary complications sharply decrease after 2 weeks. Family history is a risk factor (2 members with respiratory or atopic history) or smoke exposure. Worse if both parents smoke, but mom smoking is worse than dad. LMA removal deep is associated with less complications (go figure) and propofol is better than sevoflurane (and certainly better than desflurane). Spraying the cords makes it worse (maybe due to an increased tone after aersol, but they aren't sure). End result...if you are worried, the lowest risk is to do an IV INDUCTION with propofol, place an LMA (no difference than face mask in risk) and maintain with propofol and pull it deep.
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