Postoperative respiratory adverse events in pediatric anesthesia: Risk factors, clinical implications, and management strategies

Abstract

This review aimed to comprehensively assess the risk factors, clinical implications, and management strategies related to postoperative respiratory adverse events (RAEs) in pediatric anesthesia, particularly focusing on children recovering from general anesthesia. An extensive literature search was conducted across PubMed, Embase, and the Cochrane Library, prioritizing studies published from 2000 to 2025 that addressed RAEs in pediatric populations. The selected studies included randomized controlled trials, observational studies, and systematic reviews, focusing on various aspects, such as the identification of risk factors, the physiological vulnerabilities of children, and effective clinical interventions. A categorized analytical framework was employed to synthesize the findings related to risk factors, RAEs outcomes, and management strategies. The review identified multiple intrinsic and extrinsic risk factors for RAEs in pediatric patients, notably age (especially neonates and infants), recent upper respiratory infections, preexisting respiratory conditions, and specific procedural factors, such as the choice of anesthesia induction method (intravenous vs inhalational). Significant adverse outcomes, such as laryngospasm, bronchospasm, apnea, and pneumonia, often stem from the unique anatomical and physiological features of children, as well as inadequacies in postoperative management practices. Enhanced Post-Anesthesia Care Unit (PACU) monitoring and personalized anesthetic regimens have emerged as critical strategies to mitigate these risks. Furthermore, this review emphasizes the role of biomarkers, such as red cell distribution width, in predicting postoperative respirator complications. These findings suggest that a multifaceted approach is essential to reduce the incidence and severity of RAEs in pediatric anesthesia. Emphasizing the early identification of at-risk patients, tailoring anesthetic plans, and structured postoperative monitoring can significantly enhance clinical outcomes and resource optimization within healthcare systems. Continued research on predictive modeling and collaborative studies is paramount for developing evidence-based strategies that address this critical aspect of pediatric anesthesia care.