Isn't it just a cold? Why can't I have surgery?

Patient: "Ahem, ahem, doctor, I have a cold. Can the surgery tomorrow go on normally?"

Anesthesiologist: "How long have you had this cold? I need to assess you. Do you have any symptoms?"

Patient: "Isn't it just a cold? Why can't I have surgery?"

Anesthesiologist: "Having a cold is a minor matter, but being anesthetized when you have a cold could lead to serious consequences, even life-threatening situations..."

How could a mere cold become a major problem that requires the anesthesiologist to stop the operation?

The common cold we often talk about is actually the most common acute upper respiratory tract infection, which is usually caused by a viral infection and can heal itself.

If it is influenza, the systemic symptoms are obvious, generally including high fever, headache, and fatigue, and must be treated promptly.

According to the "Chinese Anesthesiology Guidelines and Expert Consensus (2020 Edition)", if the upper respiratory tract infection is caused by a common cold and has only mild symptoms, such as runny nose, surgery can be performed as planned, but the anesthesiologist should be prepared to prevent complications such as laryngospasm and bronchospasm. Because mild bronchospasm and increased airway pressure in the perioperative period are common problems in clinical anesthesia. Although severe life-threatening bronchospasm is rare, it is often more dangerous when it occurs.

In fact, both bacterial and viral infections can aggravate the condition of patients with asthma and bronchitis. The increased airway responsiveness after upper respiratory tract viral infection in normal humans can last for 3 to 4 weeks, while in children it can last for more than 8 weeks. Respiratory adverse events are the second most common cause of perioperative cardiac arrest in children, second only to cardiovascular events, among which laryngeal spasm is the most common cause of respiratory cardiac arrest.

What are the dangers of having a general anesthetic when you have a cold?

1. During general anesthesia, the anesthesiologist needs to manage the patient's respiratory circulation. Upper respiratory tract infection not only increases tracheal secretions, but the inflammatory response also leads to tracheal hyperresponsiveness, which can easily induce laryngeal spasm/bronchial spasm when placing a tracheal tube, increasing the risk of rapid hypoxia and even life-threatening conditions during anesthesia.

2. The endotracheal tube enters the patient's trachea through the inflamed area of ​​the upper respiratory tract, which may cause lower respiratory tract infection, and then lead to postoperative bronchitis, pneumonia, etc.

3. When you have a cold, the body's immunity is reduced, which is not conducive to the patient's postoperative recovery and can easily cause postoperative infectious diseases.

Under what circumstances should anesthesiologists postpone surgery on patients with colds?

If the patient has an acute upper respiratory tract infection, especially with obvious catarrhal symptoms (cough, runny nose, sneezing, nasal congestion), it is a contraindication to anesthesia, especially general anesthesia.

If the patient has symptoms of lower respiratory tract infection such as wheezing, severe cough and sputum, pneumonia, etc., there will be airway hyperresponsiveness, which can easily increase adverse respiratory events such as laryngeal spasm, bronchospasm, airway obstruction, hypoxia, etc. after anesthesia induction, and may even cause respiratory cardiac arrest.

What should anesthesiologists focus on in the preoperative evaluation of patients with colds? If a patient has a cold, a detailed preoperative evaluation is particularly important, and the anesthesiologist needs to weigh the pros and cons. Most decisions on anesthesia plans for patients with upper respiratory tract infections are not based solely on medical history, but can also be combined with physical examination results. Detailed communication between doctors, family members, and surgery is required to gain understanding and support.

Physicians should carefully evaluate the patient's symptoms and signs, including fever, nasal discharge, dry or wet cough, wheezing, changes in breathing pattern, shortness of breath, etc. At the same time, chest auscultation should be performed to check for signs of lower respiratory tract infection such as wheezing and dry or wet rales.

If it is decided to continue with the surgery, appropriate rescue measures should be prepared as a routine, an individualized anesthesia plan should be developed, and intraoperative management should be improved to minimize or avoid the risk of adverse respiratory events in patients.

So a cold is not a trivial matter, and anesthesia is not just a matter of an injection!

In short, whether or not a cold patient undergoes surgery is closely related to the patient's medical history and severity of the cold, the type of surgery, the experience of the anesthesiologist, and the method of anesthesia. Once perioperative respiratory adverse events occur, the hospitalization rate and costs will increase, and the length of hospital stay will be prolonged.

Therefore, for cold patients with obvious respiratory tract infection, the guidelines recommend that elective surgery be performed 2 to 4 weeks after the symptoms disappear! If the child has symptoms of lower respiratory tract infection such as wheezing, severe cough and sputum, pneumonia, etc., elective surgery should be postponed, and if necessary, it is best to postpone elective surgery for 4 to 6 weeks.