Baky Fady J, Milbrandt Todd A, Flick Randall, Larson A Noelle
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Spine Deform. 2018 Nov-Dec;6(6):781-786. doi: 10.1016/j.jspd.2018.05.001.
Early-onset scoliosis (EOS) is a potentially life-threatening condition that requires early intervention to prevent severe deformity and pulmonary compromise. Observational studies have demonstrated that children receiving multiple procedures requiring general anesthesia are at a higher risk for adverse neurocognitive outcomes. We sought to characterize anesthetic exposure in EOS patients and to determine risk factors for increased exposure. We hypothesized that patients treated for EOS were at risk of receiving large amounts of cumulative anesthesia in childhood because of the need for early intervention to preserve pulmonary function. We sought to determine which factors impacted the amount of anesthesia patients received over the course of treatment.
Records of all EOS patients treated at a tertiary referral center from 2000 to 2014 were reviewed. Patients with a minimum two-year follow-up, under age 10 at diagnosis, were included. Anesthesia was recorded in three categories: 1) orthopedic surgeries; 2) nonorthopedic surgeries; and 3) imaging/associated procedures. Diagnoses included congenital, idiopathic, neuromuscular, and syndromic scoliosis. Treatment groups were: observation, bracing, Mehta casting, growing spine, or fusion.
Mean cumulative anesthesia time was 1606 minutes. Patients with neuromuscular (mean 2132 minutes, p = .006) or congenital scoliosis (1875 minutes, p < .001) received more anesthesia than those with idiopathic scoliosis (754 minutes). Patients treated by fusion (2036 minutes, p < .001) or growing spine (2855 minutes, p < .001) received more anesthesia than those treated by bracing.
Disease severity, non-idiopathic diagnoses, and longer length of follow-up were associated with increased anesthesia. Patients who presented at earlier ages, and those treated by Mehta casting, were more likely to exceed three hours of anesthesia prior to age 3.
III.
早发性脊柱侧弯（EOS）是一种可能危及生命的疾病，需要早期干预以防止严重畸形和肺功能受损。观察性研究表明，接受多次需要全身麻醉的手术的儿童出现不良神经认知结局的风险更高。我们试图描述EOS患者的麻醉暴露情况，并确定增加暴露的风险因素。我们假设，由于需要早期干预以保护肺功能，接受EOS治疗的患者在儿童期有接受大量累积麻醉的风险。我们试图确定哪些因素会影响患者在治疗过程中接受的麻醉量。
回顾了2000年至2014年在一家三级转诊中心接受治疗的所有EOS患者的记录。纳入诊断时年龄小于10岁且至少随访两年的患者。麻醉记录分为三类：1）骨科手术；2）非骨科手术；3）影像学/相关检查。诊断包括先天性、特发性、神经肌肉性和综合征性脊柱侧弯。治疗组包括：观察、支具治疗、梅塔石膏固定、生长棒技术或融合手术。
平均累积麻醉时间为1606分钟。神经肌肉性脊柱侧弯患者（平均2132分钟，p = .006）或先天性脊柱侧弯患者（1875分钟，p < .001）比特发性脊柱侧弯患者（754分钟）接受的麻醉更多。接受融合手术（2036分钟，p < .001）或生长棒技术（2855分钟，p < .001）的患者比接受支具治疗的患者接受的麻醉更多。
疾病严重程度、非特发性诊断和更长的随访时间与麻醉增加有关。发病年龄较小的患者以及接受梅塔石膏固定治疗的患者在3岁之前更有可能超过3小时的麻醉时间。
III级。
