Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
Department of Orthopedic Surgery, University of California, San Francisco, CA.
J Pediatr Orthop. 2024;44(5):297-302. doi: 10.1097/BPO.0000000000002644. Epub 2024 Feb 14.
Mehta casting is a potentially curative intervention for early-onset scoliosis (EOS) that typically requires multiple anesthetics. The Food and Drug Administration (FDA) reported that >3 hours of anesthesia under the age of 3 years old may alter brain development; however, no standard exists for the duration of anesthesia during casting. The purpose of this study is to quantify the variability in anesthesia during Mehta casting. We hypothesize that significant institutional variability exists and may be attributed to modifiable factors.
An EOS registry was used to identify patients who underwent at least one Mehta casting procedure. Anesthesia exposure was quantified, and site variability was assessed by patient characteristics, cast placement, procedure type, and equipment used.
Our cohort consisted of 208 patients from 5 institutions (age 2.6±1.4 y). There were 1097 Mehta casting procedures, with 5.4±3.6 castings per patient. Of these patients, 106 (51%) were female, with an average age of 2.11±1.29 years old at the time casting was initiated. Patient etiologies included 154 idiopathic (74.0%), 22 syndromic (10.6%), 18 congenital (8.7%), 11 neuromuscular (5.3%), and 3 unknown (1.4%). Anesthesia time was 69±31 minutes and varied significantly between sites (59±14 to 117±46 min; P <0.001). Cumulative anesthesia time for patients under 3 years was 320±197 minutes with 120/161 (74.5%) patients exceeding 3 hours. Anesthesia time was lower after the FDA warning in 2016 compared with pre-2016 (71±30 vs. 66±32, P =0.008).
Patients undergoing Mehta casting are at significant risk of exceeding 3 hours of anesthesia, which the FDA has stated may be harmful for children <3 years. Significant site variability indicates that standardization protocols should be developed to encourage best practices and minimize anesthetic times.
Prognostic Level II.
Mehta 石膏矫形术是一种治疗早发性脊柱侧凸（EOS）的潜在根治性方法，通常需要多次麻醉。美国食品和药物管理局（FDA）报告称，3 岁以下儿童接受超过 3 小时的麻醉可能会改变大脑发育；然而，目前还没有关于石膏矫形术中麻醉持续时间的标准。本研究的目的是量化 Mehta 石膏矫形术中麻醉的变异性。我们假设存在显著的机构变异性，并且可能归因于可修改的因素。
使用 EOS 登记处确定至少接受过一次 Mehta 石膏矫形术的患者。通过患者特征、石膏放置、手术类型和使用的设备来评估麻醉暴露的变异性和部位变异性。
我们的队列包括来自 5 个机构的 208 名患者（年龄 2.6±1.4 岁）。共进行了 1097 次 Mehta 石膏矫形术，每名患者平均进行 5.4±3.6 次石膏矫形术。这些患者中，女性 106 例（51%），平均年龄 2.11±1.29 岁开始进行石膏矫形术。患者病因包括 154 例特发性（74.0%）、22 例综合征型（10.6%）、18 例先天性（8.7%）、11 例神经肌肉型（5.3%）和 3 例未知（1.4%）。麻醉时间为 69±31 分钟，各部位差异显著（59±14 至 117±46 分钟；P<0.001）。3 岁以下患者的累积麻醉时间为 320±197 分钟，120/161（74.5%）例患者超过 3 小时。与 2016 年 FDA 警告前相比，2016 年后的麻醉时间更低（71±30 与 66±32 分钟；P=0.008）。
接受 Mehta 石膏矫形术的患者存在超过 3 小时麻醉的显著风险，FDA 表示这可能对 3 岁以下儿童有害。显著的部位变异性表明，应制定标准化方案，以鼓励最佳实践并尽量减少麻醉时间。
预后 II 级。
