That was certainly the impression most of us had two years ago when faced with the challenges of the COVID-19 pandemic. The initial burden and human costs in ICUs were, in some areas, so high that some of us, even with an exclusive paediatric full-time background, were transferred to work in new additional adult COVID-19 ICUs. From that experience, it quickly became apparent that SARS-CoV-2 infection was associated with certain unfamiliar features. The initial sense when working in these environments was one of confusion mixed with personal discomfort. Not only did the actual care of these patients require an unusually fast response to emerging evidence, but there was also a very present potential personal threat for the healthcare providers. Thus, in parallel with the challenges of disease-specific patient care, personal protection strategies aimed at maintaining the safety of the care provider had to be developed.

At the height of the pandemic, scientific progress was extremely fast (some critical care protocols such as anticoagulation strategies could even change during a work shift), demonstrating how near impossible it is to establish evidence-based guidelines for an exponential process. COVID-19 turned out to be an unusually multifaceted disease with special features that all warranted specific investigations within a very short time. Naturally, airway and respiratory management of this new emerging respiratory virus became a focus in clinical anaesthesia. For paediatric anaesthetists, this was not completely new, as the specialty of paediatric anaesthesia has always been highly exposed to children of all ages with acute and chronic viral upper respiratory tract infections (URTI). Otherwise, healthy children commonly present with recurrent URTI for ENT procedures throughout the year or display a seasonal variation related to school or nursery attendance. Adverse events have been shown to be substantially higher in children presenting with symptoms of URTI compared with non-symptomatic patients and several institutional and national guidelines exist to guide the practitioner for best practice. Between one quarter and one third of all symptomatic children experience critical adverse peri-operative respiratory events [1], ranging from mild temporary peri-operative hypoxaemia due to increased secretions and subsequent laryngo- and bronchospasm to ongoing, prolonged oxygen requirements following elective and non-elective procedures.

Apart from postponing purely elective surgery, the incidence and severity of such critical adverse peri-operative respiratory events may be mitigated by the choice of airway management device (facemask vs. supraglottic airway vs. tracheal tube) as well as effective pre-emptive antisialagogue and bronchodilator treatment. Assuming the short-term hypoxaemic episodes are prevented or overcome in children with an active URTI, no long-term sequelae are usually expected [2, 3]. A progression to viral lower respiratory tract infection (LRTI) is uncommon in healthy children and the risk of transmitting viruses from the upper respiratory tract and hence producing a viral pneumonia is likely further reduced by the ‘antiviral’ properties of halogenated volatile anaesthetic agents [4, 5].

这肯定是我们大多数人两年前面对 COVID-19 大流行病挑战时的印象。在某些地区，重症监护病房的初始负担和人力成本如此之高，以至于我们中的一些人，即使具有专门的儿科全职背景，也被转移到新的成人 COVID-19 重症监护病房工作。从那次经历中，人们很快发现 SARS-CoV-2 感染与某些不熟悉的特征有关。在这些环境中工作时的最初感觉是混乱和个人不适。这些患者的实际护理不仅需要对新出现的证据做出异常快速的反应，而且对医疗保健提供者也存在非常现实的潜在个人威胁。因此，在应对特定疾病患者护理的挑战的同时，

在大流行的高峰期，科学进步非常快（抗凝策略等一些重症监护方案甚至可能在轮班期间发生变化），这表明为指数过程建立循证指南几乎是不可能的。事实证明，COVID-19 是一种异常多方面的疾病，具有特殊的特征，所有这些都需要在很短的时间内进行专门的调查。自然地，这种新出现的呼吸道病毒的气道和呼吸管理成为临床麻醉的焦点。对于小儿麻醉师来说，这并不是全新的，因为小儿麻醉的专业一直高度暴露于所有年龄段的急性和慢性病毒性上呼吸道感染 (URTI) 儿童。否则，健康儿童通常在一年中因耳鼻喉科手术而出现复发性 URTI，或表现出与学校或托儿所出勤有关的季节性变化。与无症状患者相比，出现 URTI 症状的儿童的不良事件已被证明要高得多，并且存在一些机构和国家指南来指导从业者最佳实践。在所有有症状的儿童中，有四分之一到三分之一经历过严重的不良围手术期呼吸事件 [ 与无症状患者相比，出现 URTI 症状的儿童的不良事件已被证明要高得多，并且存在一些机构和国家指南来指导从业者最佳实践。在所有有症状的儿童中，有四分之一到三分之一经历过严重的不良围手术期呼吸事件 [ 与无症状患者相比，出现 URTI 症状的儿童的不良事件已被证明要高得多，并且存在一些机构和国家指南来指导从业者最佳实践。在所有有症状的儿童中，有四分之一到三分之一经历过严重的不良围手术期呼吸事件 [1 ]，范围从由于分泌物增加和随后的喉和支气管痉挛导致的轻度暂时性围手术期低氧血症到择期和非择期手术后持续、长时间的氧气需求。

除了推迟纯择期手术外，通过选择气道管理装置（面罩与声门上气道与气管插管）以及有效的先发制人抗唾液酸和支气管扩张剂治疗。假设活动性 URTI 儿童的短期低氧血症发作得到预防或克服，通常预计不会出现长期后遗症 [ 2, 3 ]。病毒性下呼吸道感染 (LRTI) 的进展在健康儿童中并不常见，并且卤化挥发性麻醉剂的“抗病毒”特性可能会进一步降低从上呼吸道传播病毒并因此产生病毒性肺炎的风险 [ 4 ] , 5 ]。