Immunization and anesthesia – an international survey

Abstract

There is no direct evidence of any major interaction between immunization and commonly used anesthetic agents and techniques in children, but it is possible that immunosuppression caused by anesthesia and surgery may lead to decreased vaccine effectiveness or an increased risk of complications. In addition, diagnostic difficulty may arise if a recently immunized child suffers from postoperative pyrexia or malaise. The aim of this study was to ascertain anesthetists' attitudes and practices regarding anesthesia and immunization. We conducted an international survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and the Society for Paediatric Anaesthesia of New Zealand and Australia (SPANZA). Two hundred and ninety-six (52.1%) APAGBI and 86 (49.4%) SPANZA responses were analyzed. There was no consensus of approach to this theoretical risk among respondents. In total, 60% of respondents would anesthetize a child for elective surgery within 1 week of receiving a live attenuated vaccine, but 40% would not. Few hospitals have formal policies on this issue and government guidance is based on a lack of evidence for adverse events rather than positive evidence of safety. There is a theoretical risk associated with anesthesia and surgery in recently immunized children. An international postal survey failed to find a consensus to this risk among pediatric anesthetists. From a risk management perspective, a review of the available evidence suggests that it would be prudent to adopt a cautious approach where the timing of elective surgery is discretionary. We therefore recommend that elective surgery and anesthesia should be postponed for 1 week after inactive vaccination and 3 weeks after live attenuated vaccination in children.