Is it safe to administer anesthesia to a patient with an active sinus infection and mild fever (hyperthermia) for a scheduled lip repair surgery?

Postponing Anesthesia in a Patient with Active Sinus Infection and Fever

Anesthesia should be postponed for a patient with an active sinus infection and temperature of 100.3°F scheduled for lip repair surgery due to increased risk of perioperative complications. 1

Risk Assessment for Patients with Fever and Infection

• Fever (temperature of 100.3°F/38°C) is a major symptom that should raise concern in the preoperative period, particularly for elective procedures 1
• Active sinus infection represents an ongoing inflammatory process that can complicate anesthesia administration and postoperative recovery 2
• For planned surgeries, postponing the intervention is recommended when patients present with symptoms of active infection 1

Specific Risks of Proceeding with Surgery

• Anesthesia impairs normal thermoregulatory mechanisms, which may worsen existing fever and potentially lead to more severe complications 3
• Active sinus infections can spread to surrounding structures during surgery, particularly with airway manipulation required for general anesthesia 4
• Lip repair surgery is considered elective and can be safely postponed until the infection resolves 1
• Proceeding with surgery during active infection increases risk of:
  • Spread of infection to other sites 4
  • Compromised surgical outcomes 2
  • Potential for more severe postoperative complications 1

Recommended Management Algorithm

1. Postpone the elective lip repair surgery until the sinus infection has resolved and the patient has been afebrile for at least 24-48 hours 1
2. Treat the underlying sinus infection appropriately:
   • Nasal saline irrigation and intranasal corticosteroid sprays as first-line treatment 2
   • Consider appropriate antibiotics if bacterial infection is suspected 2
3. Monitor temperature regularly and document resolution of fever 1
4. Reschedule surgery after:
   • Complete resolution of all symptoms of sinus infection 1
   • Patient has been afebrile (without antipyretics) for at least 24-48 hours 1

Important Considerations and Pitfalls

• Even mild fever (100.3°F) indicates active inflammatory/infectious process that can be exacerbated by the stress of surgery and anesthesia 3
• Do not rely solely on antipyretic medications to normalize temperature before surgery, as this masks the underlying infection without treating it 1
• Always inquire about recent antipyretic use when assessing preoperative fever, as medications like acetaminophen can temporarily normalize temperature while infection remains active 1
• Nasal/sinus infections pose particular risks for airway procedures and can complicate endotracheal intubation 4, 5

While rare, proceeding with anesthesia in the setting of active infection could potentially lead to serious complications including spread of infection, respiratory complications, and poor surgical outcomes 6, 5. The benefits of postponing this elective procedure clearly outweigh the risks of proceeding.