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Bilateral transient radial nerve palsies in an infant after cardiac surgery
1Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Japan. shime@koto.kpu-m.ac.jp
Insights
Infants undergoing cardiac surgery may develop transient radial nerve palsies due to prolonged splinting. This condition, characterized by wrist and finger drop, typically resolves spontaneously after several days.
Area of Science:
- Pediatric Surgery
- Neurology
- Critical Care Medicine
Background:
- Cardiac surgery in infants can necessitate perioperative interventions like splinting for vascular access and support.
- Complications such as cardiogenic shock, hypoxemia, and edema are potential risks in this patient population.
Observation:
- A one-month-old infant developed bilateral wrist and finger drop following cardiac surgery and prolonged splint application.
- Neurological examination ruled out median or ulnar nerve involvement, suggesting a specific peripheral nerve injury.
- Symptoms resolved spontaneously within days, indicating a transient nature of the nerve dysfunction.
Findings:
- The clinical presentation was consistent with bilateral transient radial nerve palsies, specifically affecting the posterior interosseous nerve.
- Prolonged compression from splinting and adhesive tape likely caused ischemic damage to the radial nerve branches.
- Factors like diminished oxygen delivery and edema may have exacerbated the nerve ischemia.
Implications:
- This case highlights the risk of compression neuropathy, particularly radial nerve injury, from prolonged splinting in infants.
- Strategies to minimize splinting duration and frequency in sedated or paralyzed infants are crucial to prevent such complications.
- Awareness among clinicians is essential for early recognition and management of peripheral nerve injuries in pediatric surgical patients.
Purpose:
To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery.
Clinical Features:
A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days.
Conclusion:
Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.