Pediatric anesthesia – potential risks and their assessment: part I

Abstract

Obesity Childhood obesity is increasing rapidly and affects up to one third of the pediatric population (1,2). In order to assess the degree of obesity, body mass index (BMI) is assessed using age and sex-related reference curves as BMI changes substantially with age. Obese children have nearly a twofold increase in perioperative adverse events compared with normal-weight children (2). BHR, asthma, and respiratory tract infections are more common in obese than normal children (3–5) Additionally, functional residual capacity and forced vital capacity are reduced in obese children and the prevalence of OSAS is higher (2,6). Hypertension, noninsulin-dependent diabetes mellitus, gastroesophageal reflux and potentially delayed gastric emptying times are also more frequent (2). Appropriate dosing regimes for obese children rarely exist and most drugs should be given according to lean body weight, which might be difficult to determine. In the perioperative period, an increased risk of respiratory depression and higher prevalence of OSAS should be taken into account and great care taken to avoid hypoxemia in this high-risk population.