Coronavirus disease 2019 and pediatric anesthesia

This review article looks back at the lessons learned since the start of the coronavirus pandemic for providing safe and effective care to paediatric patients with known and suspected COVID-19 infections as well as identifying continuing gaps in our knowledge with regard to children.

Key points focus on the much lower likelihood of typical symptomatology of COVID-19 in children with comparison to adults. This leads to the important as yet unanswered question determining the sensitivity and optimal timing of pre-procedure tests in children as there remains suspicion that not only might children be silent asymptomatic spreaders of the disease, but they may in fact have a higher viral load in the upper airways than some critically ill adults.

General principles in the operating room involve appropriate PPE during AGPs, different airway techniques and vaccination. The risk of aerosol spread from newborns appears to be much lower but the risk of transmission from any child remains unquantified and is mitigated by the factors mentioned above as well as attention to pre-procedure testing and safe transport of patients throughout their perioperative journey.

Of particular note to children is the rare but well documented physiologic response of multisystem inflammatory syndrome in children (MIS-C). Long-term implications remain unknown and should alert the treating physician to conduct a thorough review of systems focusing specifically on any cardiac issues which may lead to haemodynamic instability.

Further questions remain on the optimum timing of rescheduled surgeries following infection with regard to perioperative complications as well as transmission risks to staff. Some have suggested 10 days, but this remains open to debate.

In conclusion we can and have successfully provided care to children during this pandemic.

Questions remain regarding how further mutations of the virus may influence infectious risk, vaccination success and transmissibility in the future. In addition, the large number of unvaccinated children combined with the unknown perioperative risks and timing of surgery in infected individuals will continue to raise questions and anxiety for paediatric anaesthetists who must adapt their practice in line with updated knowledge and evidence.

Reviewed by Dr Katherine Lanigan