Anaesthesia risks for children with pulmonary hypertension too high despite new treatments
Despite effective new treatments for their disease, children with pulmonary hypertension are still a high-risk group for serious complications and death related to anaesthesia and surgery, according to a study published in Anesthesia & Analgesia.
“The risk for adverse events during anesthesia in patients with pulmonary hypertension remains high, despite newer disease-modifying treatments,” reports the study by Katherine Taylor and colleagues of the Hospital for Sick Children, Toronto. Younger children and those with more severe disease are at higher risk, but larger studies will be needed to understand the risks of anaesthesia in the era of modern treatments for pulmonary hypertension.
The researchers analysed adverse events in 122 infants and children with pulmonary hypertension undergoing surgery with general anaesthesia between 2008 and 2012 and evaluated patterns of complications occurring under current approaches to managing pulmonary hypertension. The patients, with a median age of 2.2 years, underwent a total of 264 non-heart surgeries. In most patients, pulmonary hypertension was related to congenital heart defects, and 43 per cent of operations were performed while the children were receiving the newer disease-modifying treatments. Minor complications occurred in about four per cent of procedures and major complications in a little over three per cent. Three children died, for a risk of about one per cent per surgery. These adverse outcome rates were in the range reported by previous studies, before the new pulmonary hypertension treatments were introduced.
Complication rates were somewhat lower for children receiving the new disease-modifying drugs: 4.1 percent versus 8.6 percent for overall complications, and 2.5 versus 3.7 percent for serious complications. However, after adjustment for the severity of pulmonary hypertension, the new treatments had no significant effect on complication risk.
Age and pulmonary hypertension severity are key risk factors
On further analysis, rates of complications and death remained significantly higher for children with more severe pulmonary hypertension – including those receiving home oxygen therapy and those undergoing lengthier surgical procedures. Age was also a strong risk factor, with younger children being at higher risk. The risk of serious complications was six times higher for infants younger than five months, compared to those aged two years or older.
“The risk for adverse events during anaesthesia in patients with pulmonary hypertension remains high, despite newer disease-modifying treatments,” wrote Taylor, noting that their study is the largest to date of infants and children with pulmonary hypertension, and the only one performed since the effective new pulmonary hypertension treatments were introduced.
Further collaborative studies will be needed to address unanswered questions about the risks of surgery and anesthesia in children with pulmonary hypertension.
The impact of targeted therapies for pulmonary hypertension on pediatric intraoperative morbidity or mortality. DOI: 10.1213/ANE.0000000000000547)
Source: International Anesthesia Research Society