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Prevalence of unsuspected myopathy in infants presenting for clubfoot surgery
G Zanette1, G Manani, G Pittoni
1Anaesthesiology and Intensive Care Institute, University of Padua, Italy.
Insights
This study found a high prevalence of myopathies in infants undergoing clubfoot surgery. Regional anesthesia with monitoring is recommended for these pediatric patients to prevent complications.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Anesthesiology
Background:
- Clubfoot surgery in infants requires careful anesthetic management.
- Undiagnosed myopathies can pose risks during anesthesia.
Purpose of the Study:
- To evaluate the prevalence of myopathies in pediatric patients undergoing clubfoot surgery.
- To assess the safety and efficacy of regional anesthesia in this population.
Main Methods:
- Seventeen infants undergoing clubfoot surgery were studied.
- Electromyography and muscle biopsy were performed during surgery.
- Procedures utilized regional anesthesia (caudal or spinal) with light general anesthesia.
Main Results:
- A high rate of myopathic changes (70%) was detected via electromyography and muscle biopsy.
- No major cardiorespiratory, neurological, or malignant hyperthermia complications occurred.
- Clubfoot surgery under regional anesthesia was safely performed.
Conclusions:
- Pediatric patients undergoing clubfoot surgery exhibit a high prevalence of myopathies.
- Regional anesthesia with adequate monitoring is a safe approach for these patients.
- Preoperative screening for neuromuscular disorders may be beneficial.
Abstract:
The objective of this study was an evaluation of the prevalence of myopathies in paediatric patients scheduled for orthopaedic surgery (clubfoot) performed under regional anaesthesia. Seventeen infants scheduled for lower limb orthopaedic surgery were studied to verify coexisting neuromuscular disorders with electromyography and muscle biopsy during surgery. All surgical procedures were performed under caudal block or spinal anaesthesia, associated with light general anaesthesia. No major cardiorespiratory, neurological or malignant hyperthermic complications (muscle rigidity, arrhythmias, hyperpyrexia) were observed. Combined neurological, electromyographic and biopsy studies showed a high rate of myopathic changes (70%). Performance of clubfoot surgery under light general anaesthesia with regional techniques was free from any problems. The high rate of myopathic changes (70%) observed in the muscle biopsies suggests that precautions should be taken with paediatric patients for clubfoot surgery and a regional anaesthesia technique with adequate monitoring may be helpful to prevent possible malignant hyperthermia related problems.