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Cumulative Anesthesia Exposure in Patients Treated for Early-Onset Scoliosis

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Abstract

Background

Early-onset scoliosis (EOS) is a potentially life-threatening condition that requires early intervention to prevent severe deformity and pulmonary compromise. Observational studies have demonstrated that children receiving multiple procedures requiring general anesthesia are at a higher risk for adverse neurocognitive outcomes. We sought to characterize anesthetic exposure in EOS patients and to determine risk factors for increased exposure. We hypothesized that patients treated for EOS were at risk of receiving large amounts of cumulative anesthesia in childhood because of the need for early intervention to preserve pulmonary function. We sought to determine which factors impacted the amount of anesthesia patients received over the course of treatment.

Methods

Records of all EOS patients treated at a tertiary referral center from 2000 to 2014 were reviewed. Patients with a minimum two-year follow-up, under age 10 at diagnosis, were included. Anesthesia was recorded in three categories: 1) orthopedic surgeries; 2) nonorthopedic surgeries; and 3) imaging/associated procedures. Diagnoses included congenital, idiopathic, neuromuscular, and syndromic scoliosis. Treatment groups were: observation, bracing, Mehta casting, growing spine, or fusion.

Results

Mean cumulative anesthesia time was 1606 minutes. Patients with neuromuscular (mean 2132 minutes, p = .006) or congenital scoliosis (1875 minutes, p < .001) received more anesthesia than those with idiopathic scoliosis (754 minutes). Patients treated by fusion (2036 minutes, p < .001) or growing spine (2855 minutes, p < .001) received more anesthesia than those treated by bracing.

Conclusions

Disease severity, non-idiopathic diagnoses, and longer length of follow-up were associated with increased anesthesia. Patients who presented at earlier ages, and those treated by Mehta casting, were more likely to exceed three hours of anesthesia prior to age 3.

Level of Evidence

III

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Fady J. Baky BS, Todd A. Milbrandt MD, MS & A. Noelle Larson MD

  2. Department of Anesthesiology, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Randall Flick MD, MPH

Authors
  1. Fady J. Baky BS
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  2. Todd A. Milbrandt MD, MS
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  3. Randall Flick MD, MPH
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  4. A. Noelle Larson MD
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Corresponding author

Correspondence to A. Noelle Larson MD.

Additional information

Author disclosures: FJB (none), TM (grants from the National Institutes of Health [NIH], during the conduct of the study; and other from Paediatric Orthopaedic Society of North America, board of directors; Orthopediatrics, consultant; Broadwater, course director), RF (none), ANL (grants from NIH, during the conduct of the study; other from K2M, Orthopediatrics, outside the submitted work).

Funding: ANL was supported by an NIH grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. (R03 AR 66342); FJB was supported by an NIH T32 Musculoskeletal Training grant.

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Baky, F.J., Milbrandt, T.A., Flick, R. et al. Cumulative Anesthesia Exposure in Patients Treated for Early-Onset Scoliosis. Spine Deform 6, 781–786 (2018). https://doi.org/10.1016/j.jspd.2018.05.001

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.001

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