Systems for prediction of the risk of perioperative complications in pediatric otorhinolaryngology

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Objective. To analyze prognostic significance of ASA, MSSAR and NARCO-SS risk assessment systems in children undergoing ENT surgery under general anesthesia. Material and methods. There were 141 patients aged 1—17 years. Preoperative clinical status, perioperative complications and necessary therapeutic measures were estimated. Clinical examination included detection of concomitant diseases, rhinomanometry, sonography and analysis of heart rhythm variability. Preoperative condition of children was assessed by using of ASA, MSSAR and NARCO-SS scales. Perioperative complications included heart rhythm disorders, arterial hypertension, desaturation <90%, apnea, pain, delirium, postoperative nausea and vomiting. Discriminatory ability of prognostic scales was evaluated by using of ROC analysis, calibration — Kramer correlation coefficients and Pearson association χ2. Prognostic accuracy was estimated by using of Brier test. Results. Perioperative morbidity and necessary curative measures were loosely related to ASA, MSSAR and NARCO-SS risk classes. NARCO-SS scale showed the best discriminating ability (ACC ROC >0.64; p<0.048) and calibration (χ2>13.1). Poor electoral capacity and calibration were observed for ASA and MSSAR scales. Brier values 0.27—0.49 indicate low validity of ASA, MSSAR and NARCO-SS systems in pediatric ENT surgery. Conclusion. NARCO-SS prediction system is characterized by the greatest prognostic significance. However, its application in pediatric ENT surgery is limited due to weak selectivity.

Keywords:

children

perioperative complications of anesthesia

risk of anesthesia

ENT-surgery

Authors:

Rybiyanov V.V.

Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia;
Akhunbayev Kirghiz State Medical Academy, Bishkek, Kyrgyzstan

Aleksandrovich Yu.S.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

Pshenisnov K.V.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

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