Prepared by Alan R. Tait PhD
University of Michigan Hospitals and Health Center
Ann Arbor, Mi
My child has a cold. Should his/her surgery be cancelled?
In the past, children with colds had their anesthesia and surgery cancelled until they felt better. This practice was based on concerns that the anesthetic made the cold worse and increased the risk of complications during surgery. Nowadays, we know much more about the effects of anesthesia on colds such that cancellation of surgery for children with colds is much less common.
An important role of the anesthesiologist is to ensure that your child breathes freely when asleep for surgery. This is more of a challenge when a child has a cold because they may have a lot of secretions and their air passages may be more sensitive. Sometimes this can result in coughing and spasm of the airways. Although these events, if they occur, are typically mild and easily treated, they can be troublesome.
The decision to cancel surgery for the child with a cold is based on a number of factors. Typically, children whose cold is limited to the nose and upper parts of the throat, whose secretions are clear, who do not have a fever, and who do not feel sleepy or lethargic can be safely anesthetized. Children who look sick, who have a fever (over 100°F) and have yellow or green secretions probably should have their surgery cancelled. Other factors may also be important including the urgency of the surgery. These decisions should be made in consultation with your anesthesiologist and surgeon who can determine whether cancellation of surgery is necessary.
My child's surgery was cancelled because of a cold. How long should I wait to reschedule surgery?
Research has shown that children with colds may have sensitive air passages for several weeks after the symptoms have gone. Because a child with sensitive air passages is more likely to have complications during surgery, it is usually good practice to wait several weeks until the airways have had a chance to fully recover. The length of time that you should wait before rescheduling surgery varies but should be decided in consultation with your anesthesiologist and surgeon. Since your child's surgery was canceled, it is probably because his or her symptoms were severe enough to be worrisome. In these cases the recommended wait time is 4 or more weeks. This should allow the air passages sufficient time to recover. If your child was diagnosed with a bacterial infection of the lungs or airways, he/she should receive antibiotics and surgery postponed for at least 4 weeks.
Will the fact that my child has a cold increase the risk of problems during and after surgery?
Research has shown that children with colds have slightly more complications during anesthesia than children who are healthy. Because children with colds have more secretions and may have more sensitive airways, they are more susceptible to the effects of the anesthetic gas and to the anesthesiologist's contact with their air passages. This can cause coughing, spasm of the airways, and a lowering of oxygen in the blood. It is important to note, however, that these complications are typically mild and can be easily anticipated, recognized, and treated.
Studies of children with colds who require surgery have identified a number of factors that may increase the chance of complications. These include: a history of asthma, children who require a breathing tube for their surgery, children who have a lot of secretions or nasal congestion, surgery that involves the airways (e.g., tonsillectomy), exposure to tobacco smoke, a history of snoring, history of prematurity, and the type of anesthetic gas or drugs used. Although there are rare cases of children with colds who developed pneumonia after anesthesia and surgery, there has been no proof to suggest that the anesthetic was the direct cause. Indeed, studies show that anesthesia does not appear to prolong the cold or make it worse in most children.
Because my child has a cold, will his/her regular anesthetic care be changed in any way?
Regardless of whether your child has a cold or not, he/she will receive the best possible monitoring and care. Children with colds tend to have more secretions and may have more sensitive air passages. Because of this, your child's care may be modified slightly but will still employ standard techniques. Firstly, it will be important to remove as much of the secretions as possible. This can be done by careful suctioning of the nose and air passages and in some cases a drug may be given to dry up the secretions. Also, it will be important to give your child fluids through an IV (catheter in the arm) to prevent their secretions from becoming too thick. As per standard practice, your child will also be monitored continuously to measure the oxygen levels in their blood. If your child requires a breathing tube during surgery, then the anesthesiologist might choose one that limits contact with the sensitive parts of the airway. Sometimes too, the anesthesiologist will select an anesthetic gas or drug that will avoid or reduce irritation of the air passages. Despite all best efforts, complications can and sometimes do occur. It should be noted however that should this happen, anesthesiologists have at their disposal, a host of drugs and techniques available that can simply and effectively treat any problem.