Pediatric Overweight a Poor Predictor of Anesthesia-related Airway Complications

Background: The prevalence of childhood obesity has increased over the past four decades. Obesity in adults presents with co-morbid conditions such as hypertension, orthopedic dysfunction and non-insulin dependent diabetes mellitus. Obese adults also have a higher risk for anesthetic complications. Little data are available to draw the same conclusions in the pediatric population. Objective: This study assessed whether children 2-6 years old classified as overweight by the Centers for Disease Control (BMI-for-age above the 85^th percentile) had greater incidence of intra-anesthetic complications during general anesthesia. Methods: A case cohort design was used in which children presenting with severe early childhood caries (S-ECC) and free-standing (free from any respiratory morbidity) overweight, as well as controls were treated under general anesthesia. A standardized dentist-anesthesiologist assessed six respiratory variables including breath holding, laryngospasm, bronchospasm, hypersecretion, airway obstruction and coughing. Additionally, number of IV attempts and surgical times (anesthesia induction/surgery time/recovery times) were recorded. Results: Data were collected from 101 children (50 Controls, 51 overweight). The mean BMI percentile for age for the control group was 52±23, and for the overweight group 93±5 (p<.0001). There were no significant differences noted in any of the six respiratory-based variables. While overweight children did have a significantly longer ‘surgery time’ (p<.0001), the clinical significance (four minutes) is questionable. There were no differences in recovery time, induction time or number of IV attempts between the two groups. Conclusion: Overweight children did not have increased incidences of anesthesia-associated respiratory complication associated with general anesthesia. In the absence of respiratory co-morbidities, overweight children did not demonstrate increased risk for anesthesia complications in minimally invasive outpatient procedures.