Anesthesia complications in COVID-19 positive pediatric patients: Results from a rapid literature review and meta-analysis

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.