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Reversible coma in children after improper baclofen pump insertion
Keith J Anderson1, Jean-Pierre Farmer, Karen Brown
1Department of Pediatric Anaesthesia, Neurosurgery and Oncology Montreal Childrens' Hospital, McGill University Healthcare Center, Montreal, Quebec, Canada. maria.distefano@muhc.mcgill.ca
Insights
Delayed coma occurred in children after baclofen pump surgery due to accidental intrathecal baclofen overdose. This report details the events and suggests methods to prevent this serious complication.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Pharmacology
Background:
- Intrathecal baclofen pumps are used for managing spasticity in children.
- Postoperative complications can arise from device implantation and medication delivery.
Observation:
- Five out of nine pediatric patients developed delayed-onset coma after baclofen pump surgery.
- This complication occurred consecutively in the patient cohort.
Findings:
- The coma was suspected to result from inadvertent intrathecal baclofen bolus administration.
- Improper surgical technique is implicated as the cause of the overdose.
Implications:
- Highlights a critical risk associated with intrathecal baclofen pump surgery in children.
- Suggests the need for refined surgical techniques and protocols to prevent accidental bolus administration.
- Emphasizes the importance of vigilant postoperative monitoring for neurological changes.
Abstract:
We report the occurrence of delayed postoperative coma in five of nine consecutive children following surgery for insertion of baclofen infusion pumps. We suspect that improper technique resulted in an inadvertent administration of an intrathecal baclofen bolus. We suggest ways to minimize this risk.