Several children with CLS, my son included, have experienced breathing difficulties after undergoing anesthesia—the airways closed and breathing was obstructed. In Davis’s case, his throat suddenly closed about 24 hours after his scoliosis surgery—he turned blue and had to have his airways forced open again with air pressure. It happened again 30 minutes later. Needless to say, this is very scary.

The following article addresses the incidence of these types of complications in the general population. We have no way of knowing at this time how much higher the risks are for CLS children than the general population, although there is evidence in other syndromes that the risks are higher in children who have low muscle tone or abnormal jaw or airway construction. I conducted an informal survey among the parents and found that 3 out of 6 of those children who underwent anesthesia reported complication. —MCH

For the complete text of the following article, please see:

In this talk we shall review the factors associated with increased post-discharge complication rates, and what actions anesthesiologists can take to reduce this. As previous speakers have discussed the role of preoperative evaluation, general, regional and sedation techniques, these will not be discussed in detail except where they concern the possibility of post-anesthetic complications. However, it is obvious that post-discharge complications cannot be considered in isolation but as part of the overall management of the patient extending from the preoperative evaluation till the patient is ready to resume normal daily activities.

Recovery from ambulatory surgery occurs in three phases—early, intermediate and late. Early or Phase 1 recovery occurs in the Post-Anesthesia Care Unit where close observation by a nurse is essential until the patient demonstrates return to consciousness, the ability to maintain a patent airway and normal oxygen saturation in room air. During this phase, the patient is recumbent and the nurse-patient ratio is usually 1:2 or lower. In the intermediate phase (Phase 2 recovery) the patient continues to recover sitting up in a chair or often on the parent’s lap. Patient care is usually provided by the parents during this phase and the routine of frequent cardio-respiratory monitoring by the nurses that was justified during Phase 1 often upsets the child and may be limited during Phase 2 recovery. The third or final phase occurs at home where the child gradually returns to a normal playful level of activity and the caretakers resume their daily routine.

Postanesthetic complications may occur during any of the 3 phases of recovery, but the serious problems occur most often during Phase 1. These include hypoxemia during transport from the operating room to the Post Anesthesia Care Unit, bleeding, airway obstruction, croup, pain, nausea and vomiting, emergence delirium. In Phase 2 the major problems relate to bleeding, nausea and vomiting, pain, dizziness and excessive drowsiness. In Phase 3 problems reported include pain, nausea and vomiting, bleeding and behavioral changes.

INCIDENCE OF COMPLICATIONS

There are few large studies of the overall mortality and morbidity associated with anesthesia in pediatric patients. These include a study from Canada, a study from France and the Closed Claims study from the USA. The intraoperative complication rates for neonates and infants are higher than for older children or adults. The overall major complication rates for pediatric inpatients have been reported as 7 per 10,000 in another study, but again the rate in infants was much higher (43 per 10,000 vs. 5 per 10,000 for older children).3 However, the intraoperative complication rates for older children (beyond 2 years of age) are similar to those in adults (9/10,000 children vs. 10.6/10,000 adults). In contrast, the postoperative complication rates are much higher in children, with major life-threatening events occurring in about 4% of children vs. 0.5% of adults.

These differences are even more marked when the rates for minor complications are compared. In the Canadian study, approximately 21% of children had minor complications in the first three postoperative days compared to 9.4% of adults. The most common problems in neonates were respiratory and cardiovascular, while older children were more likely to develop nausea and vomiting, sore throat, headache and muscle pains. This may be misleading as the younger child [or developmentally delayed—MCH] is unable to express these symptoms. It must be remembered that these data refer to both inpatients and outpatients. It is highly likely that the incidence of the minor complications will be higher in the outpatient population.

Respiratory Complications: