Safety of anesthesia for children with mucopolysaccharidoses: A retrospective analysis of 54 patients

Vittorio Scaravilli, Alberto Zanella, Valentina Ciceri, Mariagrazia Bosatra, Claudia Flandoli, Alessia La Bruna, Simone Sosio, Rossella Parini, Serena Gasperini, Antonio Pesenti, Alessandra Moretto

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Complications are common during anesthesia for patients with mucopolysaccharidoses. San Gerardo Hospital (Italy) is a reference center for mucopolysaccharidoses with a dedicated pediatric anesthesia service. Aims: This study aims to evaluate the safety of anesthesia for mucopolysaccharidoses patients, describe their anesthetic management at our institution, and assess risk factors for complications. Methods: The anesthetic charts of mucopolysaccharidoses patients admitted from January 1999 to December 2014 were retrospectively analyzed. We retrieved patients' demographics; location and type of the procedure; anesthetic approach airway management and occurrence of difficult intubation and complications and outcome at hospital discharge. A generalized linear mixed model was performed to assess risk factors for complications and difficult intubation. Results: Fifty-four consecutive children were included. The anesthetic charts of 232 procedures (52% radio-diagnostics, 15% orthopedics, 15% ear-nose-throat surgery, 10% neurosurgery, and 8% general surgery) were analyzed. Each patient underwent a median of 4 (1-6) procedures. The median age at the first procedure was 2 (1-5), and overall age was 5 (2-8) years old. One hundred and twenty-five (54%) procedures were performed in remote locations. General anesthesia was utilized for 100 (43%) procedures. No death was recorded. Twenty-one (9%) procedures had respiratory complications. Remote location anesthesia was associated with increased risk for complications (odds ratio 5.405 [1.355-28.571], P =.016). All planned intubations (n = 65) were successful. Nineteen (29%) of those were defined difficult. All emergency intubations (n = 3) failed and were rescued by laryngeal mask airways. Older age was associated with an increased risk of difficult intubation (OR 1.200 [1.019-1.436], P =.028). Conclusion: Patients with mucopolysaccharidoses are at high risk for anesthesia-related complications. Remote location anesthesia is associated with increased risk for complications, and older age is associated with increased risk for difficult intubation.

Original languageEnglish
Pages (from-to)436-442
Number of pages7
JournalPaediatric Anaesthesia
Volume28
Issue number5
DOIs
Publication statusPublished - May 1 2018

Fingerprint

Mucopolysaccharidoses
Anesthesia
Intubation
Safety
Anesthetics
Laryngeal Masks
Airway Management
Neurosurgery
Pharynx
Radio
Nose
General Anesthesia
Italy
Orthopedics
Ear
Linear Models
Emergencies
Odds Ratio
Demography
Pediatrics

Keywords

  • airway management
  • anesthesia
  • child
  • complications
  • mucopolysaccharidoses

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

Cite this

Safety of anesthesia for children with mucopolysaccharidoses : A retrospective analysis of 54 patients. / Scaravilli, Vittorio; Zanella, Alberto; Ciceri, Valentina; Bosatra, Mariagrazia; Flandoli, Claudia; La Bruna, Alessia; Sosio, Simone; Parini, Rossella; Gasperini, Serena; Pesenti, Antonio; Moretto, Alessandra.

In: Paediatric Anaesthesia, Vol. 28, No. 5, 01.05.2018, p. 436-442.

Research output: Contribution to journalArticle

Scaravilli, V, Zanella, A, Ciceri, V, Bosatra, M, Flandoli, C, La Bruna, A, Sosio, S, Parini, R, Gasperini, S, Pesenti, A & Moretto, A 2018, 'Safety of anesthesia for children with mucopolysaccharidoses: A retrospective analysis of 54 patients', Paediatric Anaesthesia, vol. 28, no. 5, pp. 436-442. https://doi.org/10.1111/pan.13379
Scaravilli, Vittorio ; Zanella, Alberto ; Ciceri, Valentina ; Bosatra, Mariagrazia ; Flandoli, Claudia ; La Bruna, Alessia ; Sosio, Simone ; Parini, Rossella ; Gasperini, Serena ; Pesenti, Antonio ; Moretto, Alessandra. / Safety of anesthesia for children with mucopolysaccharidoses : A retrospective analysis of 54 patients. In: Paediatric Anaesthesia. 2018 ; Vol. 28, No. 5. pp. 436-442.
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abstract = "Background: Complications are common during anesthesia for patients with mucopolysaccharidoses. San Gerardo Hospital (Italy) is a reference center for mucopolysaccharidoses with a dedicated pediatric anesthesia service. Aims: This study aims to evaluate the safety of anesthesia for mucopolysaccharidoses patients, describe their anesthetic management at our institution, and assess risk factors for complications. Methods: The anesthetic charts of mucopolysaccharidoses patients admitted from January 1999 to December 2014 were retrospectively analyzed. We retrieved patients' demographics; location and type of the procedure; anesthetic approach airway management and occurrence of difficult intubation and complications and outcome at hospital discharge. A generalized linear mixed model was performed to assess risk factors for complications and difficult intubation. Results: Fifty-four consecutive children were included. The anesthetic charts of 232 procedures (52{\%} radio-diagnostics, 15{\%} orthopedics, 15{\%} ear-nose-throat surgery, 10{\%} neurosurgery, and 8{\%} general surgery) were analyzed. Each patient underwent a median of 4 (1-6) procedures. The median age at the first procedure was 2 (1-5), and overall age was 5 (2-8) years old. One hundred and twenty-five (54{\%}) procedures were performed in remote locations. General anesthesia was utilized for 100 (43{\%}) procedures. No death was recorded. Twenty-one (9{\%}) procedures had respiratory complications. Remote location anesthesia was associated with increased risk for complications (odds ratio 5.405 [1.355-28.571], P =.016). All planned intubations (n = 65) were successful. Nineteen (29{\%}) of those were defined difficult. All emergency intubations (n = 3) failed and were rescued by laryngeal mask airways. Older age was associated with an increased risk of difficult intubation (OR 1.200 [1.019-1.436], P =.028). Conclusion: Patients with mucopolysaccharidoses are at high risk for anesthesia-related complications. Remote location anesthesia is associated with increased risk for complications, and older age is associated with increased risk for difficult intubation.",
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T2 - A retrospective analysis of 54 patients

AU - Scaravilli, Vittorio

AU - Zanella, Alberto

AU - Ciceri, Valentina

AU - Bosatra, Mariagrazia

AU - Flandoli, Claudia

AU - La Bruna, Alessia

AU - Sosio, Simone

AU - Parini, Rossella

AU - Gasperini, Serena

AU - Pesenti, Antonio

AU - Moretto, Alessandra

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N2 - Background: Complications are common during anesthesia for patients with mucopolysaccharidoses. San Gerardo Hospital (Italy) is a reference center for mucopolysaccharidoses with a dedicated pediatric anesthesia service. Aims: This study aims to evaluate the safety of anesthesia for mucopolysaccharidoses patients, describe their anesthetic management at our institution, and assess risk factors for complications. Methods: The anesthetic charts of mucopolysaccharidoses patients admitted from January 1999 to December 2014 were retrospectively analyzed. We retrieved patients' demographics; location and type of the procedure; anesthetic approach airway management and occurrence of difficult intubation and complications and outcome at hospital discharge. A generalized linear mixed model was performed to assess risk factors for complications and difficult intubation. Results: Fifty-four consecutive children were included. The anesthetic charts of 232 procedures (52% radio-diagnostics, 15% orthopedics, 15% ear-nose-throat surgery, 10% neurosurgery, and 8% general surgery) were analyzed. Each patient underwent a median of 4 (1-6) procedures. The median age at the first procedure was 2 (1-5), and overall age was 5 (2-8) years old. One hundred and twenty-five (54%) procedures were performed in remote locations. General anesthesia was utilized for 100 (43%) procedures. No death was recorded. Twenty-one (9%) procedures had respiratory complications. Remote location anesthesia was associated with increased risk for complications (odds ratio 5.405 [1.355-28.571], P =.016). All planned intubations (n = 65) were successful. Nineteen (29%) of those were defined difficult. All emergency intubations (n = 3) failed and were rescued by laryngeal mask airways. Older age was associated with an increased risk of difficult intubation (OR 1.200 [1.019-1.436], P =.028). Conclusion: Patients with mucopolysaccharidoses are at high risk for anesthesia-related complications. Remote location anesthesia is associated with increased risk for complications, and older age is associated with increased risk for difficult intubation.

AB - Background: Complications are common during anesthesia for patients with mucopolysaccharidoses. San Gerardo Hospital (Italy) is a reference center for mucopolysaccharidoses with a dedicated pediatric anesthesia service. Aims: This study aims to evaluate the safety of anesthesia for mucopolysaccharidoses patients, describe their anesthetic management at our institution, and assess risk factors for complications. Methods: The anesthetic charts of mucopolysaccharidoses patients admitted from January 1999 to December 2014 were retrospectively analyzed. We retrieved patients' demographics; location and type of the procedure; anesthetic approach airway management and occurrence of difficult intubation and complications and outcome at hospital discharge. A generalized linear mixed model was performed to assess risk factors for complications and difficult intubation. Results: Fifty-four consecutive children were included. The anesthetic charts of 232 procedures (52% radio-diagnostics, 15% orthopedics, 15% ear-nose-throat surgery, 10% neurosurgery, and 8% general surgery) were analyzed. Each patient underwent a median of 4 (1-6) procedures. The median age at the first procedure was 2 (1-5), and overall age was 5 (2-8) years old. One hundred and twenty-five (54%) procedures were performed in remote locations. General anesthesia was utilized for 100 (43%) procedures. No death was recorded. Twenty-one (9%) procedures had respiratory complications. Remote location anesthesia was associated with increased risk for complications (odds ratio 5.405 [1.355-28.571], P =.016). All planned intubations (n = 65) were successful. Nineteen (29%) of those were defined difficult. All emergency intubations (n = 3) failed and were rescued by laryngeal mask airways. Older age was associated with an increased risk of difficult intubation (OR 1.200 [1.019-1.436], P =.028). Conclusion: Patients with mucopolysaccharidoses are at high risk for anesthesia-related complications. Remote location anesthesia is associated with increased risk for complications, and older age is associated with increased risk for difficult intubation.

KW - airway management

KW - anesthesia

KW - child

KW - complications

KW - mucopolysaccharidoses

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