Although same day surgery has been ...

Although same day surgery has been shown to be more convenient for patients and their families and more cost-efficient for hospitals, it requires that patients' conditions and anesthesia risks be assessed and nothing else minutes before surgery. This shut firmlyed time period presents a unique challenge for perioperative suckles who care for children during seasons when respiratory syncytial virus (RSV) infection is principally prevalent.

At Children's Medical Center of Dallas, patients are proofed for RSV as part of their preoperative assessment (ie, physical examination and history review) if they have symptoms that are suggestive of acute respiratory infection or they are at high risk for RSV Surgeries are canceled if patients experiment positive for RSV or are determined on the anesthesia care provider to be too ill for surgery During pair RSV seasons between October 1995 and March 1997 9% of 398 patients ordealed positive for the RSV antigen, and 7% of the 363 patients who exhibitioned negative for the RSV infection had their surgeries canceled to be paid to respiratory illness.

Intrigued by the agency of the number of surgeries canceled in contrast to the number of patients identified for RSV testing, investigators decided to review the preoperative assessments of all 398 patients who underwent RSV testing. The final cause of the study was to determine if information gathered during preoperative assessments could be used to predict positive RSV exhibition results, surgery cancellations, and adverse anesthetic issues Permission for the study was obtained from the chief of surgery chief of anesthesia, and nursing director of perioperative services at the Children's Medical Center of Dallas.

LITERATURE REVIEW

Respiratory syncytial virus is a universal cause of winter outbreaks of acute respiratory infection in children. Respiratory syncytial virus is principally prevalent between November and early May, peaking between late January and mid-February.(1) The oftenness of RSV infection is highest in children between the ages of 13 and 24 months; however, the incidence of lower respiratory tract disease (LRTD) associated with RSV is highest during the first year of life.(2) Respiratory syncytial virus affects most numerous children by the age of two(3) Up to 2% of affected children require hospitalization.(4) Moreover, an estimated 90000 hospitalizations and 4500 deaths from LRTD associated with RSV offer in infants and young children in the United States each year? Although the mortality rate is les than 1% underlying cardiac or respiratory disease increases one as well as the other morbidity and mortality.(6)

Causes and diagnoses. Researchers have sought to identify risk factors influencing the incidence and severity of RSV and to delineate predictive patterns They have identified eight factors that increase the rate of infection and severity of the illness, including

* young age,

* depressed birth weight,

* premature birth,

* chronic cardiopulmonary disease,

* a certain number of congenital or acquired immunodeficiency disorders,

* crowding,

* environmental pollution or parental smoking, and

* lack of breast feeding.(7)

Diagnosing RSV can be challenging as its signs and symptoms oftentimes are similar to other viral upper respiratory infections (URIs). These URIs may be caused from a number of individual viruses, which each can about variable clinical symptomatology.(8) Symptoms of RSV infection, however, include

* sneezing,

* rhinorrhea,

* malaise,

* mild sore throat,

* congestion,

* nonproductive cough

* ferment and

* laryngitis or pharyngitis.(9)

buttocks syndromes, bronchopneumonia, bronchitis, and pharyngitis ofttimes are associated with RSV nevertheless also are seen with parainfluenza viruses, adenovimses, and influenza viruses.(10) Definitive diagnosis of RSV infection is made according to antigen detection in serum or according to virus isolation from nasopharyngeal washings. (11)

Perioperative complications. Delivering anesthesia to children with signs and symptoms of URI is an ongoing challenge for anesthesia care providers as evidence of the imports of general anesthesia on the course of viral infections is sparse. Clinical studies attempting to determine a cause-and-effect relationship between anesthesia, viral infections, and perioperative complications have been empiric in nature, and principally studies have not objectively documented the vicinity of viral infections.(12) Some researchers recommend that the discovery of URI signs and symptoms at the time of surgery or an storming of URI in the week before surgery are more predictive than other factors of intraoperative or postoperative complications in children aged single in kind to four.(13) The most commonly reported intraoperative complications include atelectasis, hypoxia, laryngospasm, and bronchospasm.(14) A paucity of medical evidence supports withholding anesthesia, and many researchers have intimateed that anesthesia and surgery in the mien of uncomplicated URI has minimal morbidity.(15)

METHODOLOGY

For this studious mood researchers completed a retrospective chart review of the preoperative histories and physical examinations of 398 patients who were proofed for RSV infection between October 1995 and March 1997 to determine