دورية أكاديمية
Perioperative management and outcomes for posterior spinal fusion in patients with Friedreich ataxia: A single-center, retrospective study.
| العنوان: | Perioperative management and outcomes for posterior spinal fusion in patients with Friedreich ataxia: A single-center, retrospective study. |
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| المؤلفون: | O'Brien EM; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Neiswinter N; Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania, USA.; Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA., Lin KY; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Lynch D; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Baldwin K; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Profeta V; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Flynn JM; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Muhly WT; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. |
| المصدر: | Paediatric anaesthesia [Paediatr Anaesth] 2024 Jul; Vol. 34 (7), pp. 654-661. Date of Electronic Publication: 2024 Apr 24. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Arnette-Blackwell Country of Publication: France NLM ID: 9206575 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1460-9592 (Electronic) Linking ISSN: 11555645 NLM ISO Abbreviation: Paediatr Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Paris, France : Arnette-Blackwell, c1991- |
| مواضيع طبية MeSH: | Friedreich Ataxia*/complications , Spinal Fusion*/methods , Perioperative Care*/methods, Humans ; Female ; Retrospective Studies ; Male ; Adolescent ; Postoperative Complications/epidemiology ; Treatment Outcome ; Child ; Scoliosis/surgery |
| مستخلص: | Background: Friedreich ataxia is a rare genetic disorder associated with progressive mitochondrial dysfunction leading to widespread sequelae including ataxia, muscle weakness, hypertrophic cardiomyopathy, diabetes mellitus, and neuromuscular scoliosis. Children with Friedreich ataxia are at high risk for periprocedural complications during posterior spinal fusion due to their comorbidities. Aim: To describe our single-center perioperative management of patients with Friedreich ataxia undergoing posterior spinal fusion. Methods: Adolescent patients with Friedreich ataxia presenting for spinal deformity surgery between 2007 and 2023 were included in this retrospective case series performed at the Children's Hospital of Philadelphia. Perioperative outcomes were reviewed along with preoperative characteristics, intraoperative anesthetic management, and postoperative medical management. Results: Seventeen patients were included in the final analysis. The mean age was 15 ± 2 years old and 47% were female. Preoperatively, 35% were wheelchair dependent, 100% had mild-to-moderate hypertrophic cardiomyopathy with preserved systolic function and no left ventricular outflow tract obstruction, 29% were on cardiac medications, and 29% were on pain medications. Intraoperatively, 53% had transesophageal echocardiography monitoring; 12% had changes in volume status on echo but no changes in function. Numerous combinations of total intravenous anesthetic agents were used, most commonly propofol, remifentanil, and ketamine. Baseline neuromonitoring signals were poor in four patients and one patient lost signals, resulting in 4 (24%) wake-up tests. The majority (75%) were extubated in the operating room. Postoperative complications were high (88%) and ranged from minor complications like nausea/vomiting (18%) to major complications like hypotension/tachycardia (29%) and need for extracorporeal membrane oxygenation support in one patient (6%). Conclusions: Patients with Friedreich ataxia are at high risk for perioperative complications when undergoing posterior spinal fusion and coordinated multidisciplinary care is required at each stage. Future research should focus on the utility of intraoperative echocardiography, optimal anesthetic agent selection, and targeted fluid management to reduce postoperative cardiac complications. (© 2024 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.) |
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| فهرسة مساهمة: | Keywords: Friedreich ataxia; neuromuscular scoliosis; perioperative management; posterior spinal fusion |
| تواريخ الأحداث: | Date Created: 20240424 Date Completed: 20240606 Latest Revision: 20240607 |
| رمز التحديث: | 20240607 |
| DOI: | 10.1111/pan.14896 |
| PMID: | 38655751 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1460-9592 |
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| DOI: | 10.1111/pan.14896 |