Anesthesia complications in COVID-19 positive pediatric patients: Results from a rapid literature review and meta-analysis
DOI:
https://doi.org/10.46570/utjms-2026-1153Keywords:
COVID-19, Anesthesia, Critical care, pediatricAbstract
Children are less likely to experience severe COVID-19-related complications compared to adults, they are still an understudied, vulnerable population. Given the unique challenges posed by COVID-19 in pediatric patients, effective perioperative management is essential to mitigate potential complications and ensure safe anesthesia practices. In this manuscript, the objective was to produce a systematic literature review with meta-analysis to increase the understanding of current research to help guide anesthesiologists in perioperative management. Our analysis of the literature identifies respiratory complications as a primary concern for patients undergoing anesthesia while infected with COVID-19. Three databases were searched and screened for reviews and there were 939 combined articles found. These databases are large collections of published scientific articles which were sorted through using keywords which allowed us to find and analyze these articles. After the databases were screened there were a number of articles which worked within our criteria which were looking for pediatric anesthesia patients during the beginning of the pandemic and their complications. The odds ratio was calculated for each paper to generate an overall combined effect size, heterogeneity, and publication bias. After screening and removing duplicates, 10 articles were included for further review, and 6 were eligible for meta-analysis. Their combined effect size was 3.71 (CI 2.45, 7.24, p = 0.05), heterogeneity I2=0.76, and funnel plot for publication bias demonstrated right skew. Our results show there is a statistically significant increase in modest COVID-19 complications in pediatric patients from anesthesia. These modest complications include respiratory events, use of vasopressors, cardiac, SIRS, and unplanned escalations of care. Clinically insignificant results may have been missed due to publication bias in our study. While we found statistically significant results showing an increase in pediatric complications, it is possible that clinically insignificant results could add even more to this topic so we concluded that larger, more robust, studies need to be conducted.
References
Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020;174(9):868–873. doi:10.1001/jamapediatrics.2020.1948
Rabbitts, J. A., & Groenewald, C. B. (2020). Epidemiology of Pediatric Surgery in the United States. Paediatric anaesthesia, 30(10), 1083–1090. https://doi.org/10.1111/pan.13993
Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz, and Ahmed Elmagarmid. (2016) Rayyan — a web and mobile app for systematic reviews. Systematic Reviews 5:210, DOI: 10.1186/s13643-016-0384-4.
Lo, C.KL., Mertz, D. & Loeb, M. (2014) Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol 14, 45. https://doi.org/10.1186/1471-2288-14-45
Suurmond, R, van Rhee, H, & Hak, T. (2017). Introduction, comparison, and validation of Meta-Essentials: a free and simple tool for meta-analysis. Research Synthesis Methods. 1-17. doi.org/10.1002/jrsm.1260
Peterson, M. B., Gurnaney, H. G., Disma, N., Matava, C., Jagannathan, N., Stein, M. L., Liu, H., Kovatsis, P. G., von Ungern-Sternberg, B. S., Fiadjoe, J. E., & PAWS-COVID-19 Group (2022). Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study. Anaesthesia, 77(6), 649–658. Advance online publication. https://doi.org/10.1111/anae.15716
Cronin JA, Nelson JH, Farquhar I, Braffett B, Bebu I, Pestieau SR, Geng-Ramos G, Heitmiller E, Deutsch N. Anesthetic outcomes in pediatric patients with COVID-19: A matched cohort study. Paediatr Anaesth. 2021 Jun;31(6):733-735. doi: 10.1111/pan.14177. Epub 2021 Mar 25. PMID: 33713490; PMCID: PMC8250730.
Reiter, A. J., Ingram, M. E., Raval, M. V., Garcia, E., Hill, M., Aranda, A., Chandler, N. M., Gonzalez, R., Born, K., Mack, S., Lamoshi, A., Lipskar, A. M., Han, X. Y., Fialkowski, E., Spencer, B., Kulaylat, A. N., Barde, A., Shah, A. N., Adoumie, M., Gross, E., … Berman, L. (2023). Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study. Journal of pediatric surgery, 58(8), 1543–1549. https://doi.org/10.1016/j.jpedsurg.2022.10.048
Giwangkancana G, Oktaliansah E, Ramlan AAW, Utariani A, Kurniyanta P, Arifin H, Widyastuti Y, Pratiwi A, Syukur R. Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study. Open Access Emerg Med. 2022 Sep 20;14:515-524. doi: 10.2147/OAEM.S377201. PMID: 36164588; PMCID: PMC9509001.
Lang, S. S., Gajjar, A. A., Tucker, A. M., Storm, P. B., Rahman, R. K., Madsen, P. J., O'Brien, A., Chiotos, K., Kilbaugh, T. J., & Huh, J. W. (2022). Urgent Neurosurgical Interventions in the COVID-19-Positive Pediatric Population. World neurosurgery, 158, e196–e205. https://doi.org/10.1016/j.wneu.2021.10.155
LaRiviere MJ, Shah YB, Cummings ER, Clegg K, Doucette A, Struyk BP, Lustig RA, Kurtz G, Hill-Kayser CE. General Anesthesia for Pediatric Radiation Therapy in the Era of COVID-19. Adv Radiat Oncol. 2022 Jul-Aug;7(4):100929. doi: 10.1016/j.adro.2022.100929. Epub 2022 Mar 6. PMID: 35280349; PMCID: PMC8898088.
Geng-Ramos G, Nelson J, Lee AC, Deutsch N, Challa C, Pestieau S, Rana MS, Hubbard M, Cronin JA. Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study. Paediatr Anaesth. 2023 Jan;33(1):79-85. doi: 10.1111/pan.14585. Epub 2022 Nov 7. PMID: 36314047; PMCID: PMC9877943.
Joshi, S. S., Keshava, M., Murthy, K. S., Sambandamoorthy, G., Shetty, R., Shanmugasundaram, B., Prabhu, S., Hegde, R., & Richard, V. S. (2021). Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery. Cardiology in the young, 1–6. Advance online publication. https://doi.org/10.1017/S1047951121004509
Nielson, C., Suarez, D., Taylor, I. K., Huang, Y., & Park, A. H. (2022). Surgical outcomes inchildren with perioperative SARS-CoV-2 diagnosis. American journal of infection control, 50(6), 602–607. https://doi.org/10.1016/j.ajic.2022.02.024
Saynhalath, R., Alex, G., Efune, P. N., Szmuk, P., Zhu, H., & Sanford, E. L. (2021). Anesthetic Complications Associated With Severe Acute Respiratory Syndrome Coronavirus 2 in Pediatric Patients. Anesthesia and analgesia, 133(2), 483–490. https://doi.org/10.1213/ANE.0000000000005606
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Faryal Irfan, Gavin Bennett, Sanjana Yerubandi, Dan Wright, Swamroop Nandwani (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
