Department of Anesthesiology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, China.
Department of Pediatric Orthopedics, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, China.
Paediatr Anaesth. 2022 Jul;32(7):851-861. doi: 10.1111/pan.14454. Epub 2022 May 1.
Major anesthetic risks arise in orthopedic surgeries for children with osteogenesis imperfecta, a rare genetically inherited condition presenting diverse skeletal issues.
We aimed to investigate anesthetic risks, including difficult airway, hypo- and hyperthermia, blood loss, and pain, in connection with patient, anesthetic, and surgical factors.
Both descriptive and inferential statistics were employed to study the anesthetic risks and their predictors. Data of 252 surgeries for 132 Chinese osteogenesis imperfecta patients aged 18 or below were retrieved from the authors' hospital between 2015 and 2019.
Two thirds of the cohort were Sillence type IV patients, with types I, III, and V accounting for 7.6%, 14.4%, and 11.4%, respectively. Video and direct laryngoscopy were used. No case of difficult airway was identified. Due to a careful management strategy, intraoperative temperature varied on average between -0.38°C and +0.89°C from the initial temperature. Fifty-two and 18 cases of hyper- and hypothermia were encountered, respectively. The use of sevoflurane for maintenance resulted in a mean increase of +0.24°C [95% CI 0.05 ~ 0.42] in the maximum temperature. Massive blood losses (>20% of estimated total blood volume) were observed in 18.3% of the cases. Neither intraoperative temperature changes nor blood loss was found to be related to Sillence classification. Regional anesthesia techniques were applied to 72.6% of the cases. Ultrasound guidance was used per the judgment of anesthesiologists or when in case of difficult landmarks. The incidence of difficult regional anesthesia was low (4 out of 252). For postoperative analgesia, 154 neuraxial blocks (including 77 caudal and 77 lumbar epidural) and 29 peripheral nerve blocks were performed.
Anesthesia for children with osteogenesis imperfecta undergoing complex orthopedic procedures was challenging. Proper anesthesia planning was essential for both intraoperative management and postoperative analgesia. Age, surgical duration, and use of sevoflurane for maintenance impacted the intraoperative temperature most, and massive blood loss was not uncommon. The risks for airway or regional anesthesia difficulties were low. Pain scores could be controlled to be ≤3 via multiple techniques.
成骨不全症是一种罕见的遗传性疾病，会导致骨骼出现多种问题，儿童在骨科手术中会面临较大的麻醉风险。
我们旨在研究与患者、麻醉和手术相关的麻醉风险，包括困难气道、低体温和高体温、失血和疼痛。
采用描述性和推断性统计学方法研究麻醉风险及其预测因素。我们从作者医院 2015 年至 2019 年期间的病历中检索了 252 例年龄在 18 岁以下的成骨不全症患儿的 132 例手术的数据。
该队列的三分之二为 Sillence Ⅳ型患者，分别有 7.6%、14.4%和 11.4%为 I 型、III 型和 V 型患者。使用了视频喉镜和直接喉镜，未发现困难气道病例。由于采用了精心的管理策略，术中体温平均在初始体温的基础上波动了-0.38°C 至+0.89°C。分别有 52 例和 18 例出现体温过高和过低的情况。使用七氟醚维持麻醉导致最高体温平均升高+0.24°C（95%置信区间为 0.05~0.42°C）。有 18.3%的病例出现大量失血（超过估计总血容量的 20%）。术中体温变化和失血均与 Sillence 分类无关。72.6%的病例采用了区域麻醉技术。麻醉医生根据判断或在难以找到体表标志时使用了超声引导。困难区域麻醉的发生率较低（252 例中有 4 例）。术后镇痛采用了 154 例椎管内阻滞（包括 77 例骶管阻滞和 77 例腰段硬膜外阻滞）和 29 例周围神经阻滞。
为接受复杂骨科手术的成骨不全症儿童实施麻醉极具挑战性。适当的麻醉计划对于术中管理和术后镇痛都至关重要。年龄、手术时间以及使用七氟醚维持麻醉对术中体温影响最大，大量失血并不少见。气道或区域麻醉困难的风险较低。通过多种技术可以将疼痛评分控制在≤3 分。
