Acute Respiratory Complications in Children Undergoing Emergency Orthopedic Surgery: Clinical Predictors and Anesthetic Strategies – A Narrative Review

• DOI: https://doi.org/10.22533/at.ed.15953125300915

• Palavras-chave: anestesia pediátrica; complicações respiratórias; emergência ortopédica; preditores clínicos; estratégias anestésicas.

• Keywords: Pediatric anesthesia; respiratory complications; orthopedic emergency; clinical predictors; anesthetic strategies.

• Abstract: Abstract Background: Acute respiratory complications are among the most frequent perioperative challenges in pediatric anesthesia, particularly during emergency orthopedic procedures where time constraints and clinical instability increase risk. Objective: To review the current literature regarding clinical predictors of perioperative respiratory complications in children undergoing emergency orthopedic surgery and to evaluate anesthetic strategies designed to prevent and manage these events. Methods: A narrative literature review was conducted using PubMed, Embase, Scopus, and Cochrane databases. Studies published in English up to 2025 were included if they addressed respiratory outcomes, risk factors, or anesthetic approaches in pediatric emergency orthopedic surgery. Results: Epidemiological evidence highlights age under one year, recent respiratory infection, obesity, obstructive sleep apnea, high ASA classification, and major trauma as significant predictors of complications. The most common events include laryngospasm, bronchospasm, desaturation, hypoxemia, and the need for reintubation. Preventive strategies rely on careful preoperative assessment, optimal timing of intubation, use of rapid-sequence induction when indicated, short-acting anesthetic agents, protective ventilation strategies, and early postoperative monitoring. Regional anesthesia, when feasible, reduces airway manipulation and may decrease respiratory risk. Conclusion: Acute respiratory complications in pediatric emergency orthopedic surgery are strongly associated with identifiable preoperative predictors. Early recognition of risk factors and tailored anesthetic strategies are critical to improving perioperative outcomes. Prospective multicenter studies are needed to develop standardized protocols and evidence-based guidelines.