• J Valdivia Santandreu and S Alavedra Peñalba.
• Servicios de Anestesiología, Hospital General de Palma de Mallorca. valdiv@arrakis.es
• Rev Esp Anestesiol Reanim. 2001 Apr 1;48(4):188-91.

AbstractA 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy. The main features of his case history were chronic otitis media, bronchial asthma and signs and symptoms of upper respiratory tract infection (persistent runny nose and cough, occasionally with fever). Immediately after tracheal intubation we observed that the right side of the chest failed to rise with inspiration; breathing sounds were absent on the right and hypoxemia developed. A chest film taken in the operating room revealed upper right lobe atelectasis. Surgery was postponed and tracheobronchial lavage was performed with fiberoptic bronchoscopy and aspiration of mucous plugs. Upper airway infections are a common problem in children and increase the risk of respiratory complications during anesthesia. Patients with upper respiratory tract symptoms present a dilemma, and consensus about how to deal with such situations is lacking. We review the literature, discuss the anesthetic implications of upper airway infections, and suggest a two-phase approach for cases such as we report: first myringotomy using general anesthesia and a face mask, and second, once the upper airway infection has resolved, adenoidectomy with general anesthesia and tracheal intubation.

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