Anesthesia Concerns in Congenital Anomalies of the Upper Extremity

  • Ann F. T. Lawrence
  • Emily L. A. Stebbins
  • Borzoo Farhang
Chapter
First Online:

Abstract

Children with deformities of the upper extremity often have multiple congenital anomalies. These children have special needs every step that require specific planning and vigilance to ensure safe, effective, and exemplary delivery of anesthetic care. Preoperative discussions with surgeons, anesthesiologists, critical care physicians, pulmonologists, cardiologists, endocrinologists, geneticists, and/or nephrologists can turn what might have been a simple procedure into something more complex. These discussions should work toward a common goal of providing surgical care at the optimal time based on risk-assessment and clinical need.

Several issues that may be encountered preoperatively include anxiety, complex social situations, difficult intravenous access, an inability to tolerate safe fasting requirements, as well as common childhood problems such as upper respiratory infection. Intraoperative considerations include difficult airway management, special positioning requirements, and systemic comorbidities. Extubation, disposition, and analgesia are only a few of the concerns and potential complications that can be encountered in the postoperative period.

Keywords

Obstructive Sleep Apnea Brachial Plexus Malignant Hyperthermia Esophageal Atresia Epidermolysis Bullosa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    McGraw T. Preparing children for the operating room: psychological issues. Can J Anaesth. 1994;41(11):1094–103.PubMedCrossRefGoogle Scholar
  2. 2.
    Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg. 1997;84:427–32.PubMedGoogle Scholar
  3. 3.
    Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children: predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150(12):1238–45.PubMedCrossRefGoogle Scholar
  4. 4.
    Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–8.PubMedCrossRefGoogle Scholar
  5. 5.
    O’Byrne K, Peterson L, Saldana L. Survey of pediatric hospitals’ preparation programs: evidence of the impact of health psychology research. Health Psychol. 1997;16:147–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Saile H, Burgmeier R, Schmidt LR. A meta-analysis of studies on psychological preparation of children facing medical procedures. Psychol Health. 1988;2:107–32.CrossRefGoogle Scholar
  7. 7.
    Kain ZN, Mayes LC, Caramico LA. Preoperative preparation in children: a cross-sectional study. J Clin Anesth. 1996;8:508–14.PubMedCrossRefGoogle Scholar
  8. 8.
    McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg. 2001;93:98–105.PubMedCrossRefGoogle Scholar
  9. 9.
    Gauderer MW, Lorig JL, Eastwood DW. Is there a place for parents in the operating room? J Pediatr Surg. 1989;24(7):705–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Messeri A, Caprilli S, Busoni P. Anaesthesia induction in children: a psychological evaluation of the efficiency of parents’ presence. Paediatr Anaesth. 2004;14(7):551–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Kain Z, Mayes L, Wang S, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia vs. sedative premedication: which intervention is more effective? Anesthesiology. 1998;89:1147–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth. 2001;11:29–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg. 2005;100(1): 59–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95(2):299–306.PubMedCrossRefGoogle Scholar
  15. 15.
    Elwood T, Sarathy PV, Geiduschek JM, Ulma GA, Karl HW. Respiratory complications during anaesthesia in Apert syndrome. Pediatr Anesth. 2001;11:701–3.CrossRefGoogle Scholar
  16. 16.
    Martin S, Tobias JD. Perioperative care of the child with arthrogryposis. Pediatr Anesth. 2006;16:31–7.CrossRefGoogle Scholar
  17. 17.
    Hodge D, Fleisher G. Pediatric catheter flow rates. Am J Emerg Med. 1985;3(5):403.PubMedCrossRefGoogle Scholar
  18. 18.
    Ramasethur J, Macdonald MG. Atlas of procedures in neonatology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007.Google Scholar
  19. 19.
    Iovino F. Central venous catheterization: complications of different placements. Ann Chir. 2001;126(10):1001.PubMedCrossRefGoogle Scholar
  20. 20.
    Wilson W, Taubert KA, Gerwitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 2007;116:1736.PubMedCrossRefGoogle Scholar
  21. 21.
    Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiol Scand. 1999;43: 542–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Maxwell LG, Yaster M. Perioperative management issues in pediatric patients. Anaesthesiol Clin North Am. 2000;18:601–32.CrossRefGoogle Scholar
  23. 23.
    Davis PJ, Cladis FP, Motoyama EK, editors. Smith’s anesthesia for infant and children. 8th ed. Philadelphia: Mosby Elsevier; 2011.Google Scholar
  24. 24.
    Martin JT, Warner MA. The ventral decubitus (prone) position. In: Martin JT, Warner MA, editors. Positioning in anesthesia and surgery. Philadelphia: WB Saunders; 1997. p. 155.Google Scholar
  25. 25.
    Hanna MN, Murphy JD, Kumar K, Wu CL. Regional anesthesia and outcome: what is the evidence. Curr Opin Anaesthesiol. 2009;22:672–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001–107.PubMedCrossRefGoogle Scholar
  27. 27.
    Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87:816–26.PubMedGoogle Scholar
  28. 28.
    Markakis DA. Regional anesthesia in pediatrics. Anaesthesiol Clin North Am. 2000;18:355–81.CrossRefGoogle Scholar
  29. 29.
    Misamore G, Webb B, McMurray S, Sallay P. A prospective analysis of interscalen brachial blocks performed under general anesthesia. J Shoulder Elbow Surg. 2011;20:308–14.PubMedCrossRefGoogle Scholar
  30. 30.
    Lynn AM, Fischer T, Brandford HG, Pendergrass TW. Systemic responses to tourniquet release in children. Anesth Analg. 1986;65: 865–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Tredwell SJ, Wilmink M, Inkpen K, McEwen JA. Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use. J Pediatr Orthop. 2001;21:671–6.PubMedGoogle Scholar
  32. 32.
    Sharma JP, Salhotra R. Tourniquets in orthopedic surgery. Indian J Orthop. 2012;46(4):377–83.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Kutty S, McElwain JP. Padding under tourniquets in tourniquet controlled surgery: Bruner’s ten rules revisited. Injury. 2002;33:75.PubMedCrossRefGoogle Scholar
  34. 34.
    Sale SM. Neonatal apnoea. Best Pract Res Clin Anaesthesiol. 2010;24(3):323–36.PubMedCrossRefGoogle Scholar
  35. 35.
    Chidambaran V, Sadhasivam S. Pediatric acute and surgical pain management: recent advances and future perspectives. Int Anesthesiol Clin. 2012;50(4):66–82.PubMedCrossRefGoogle Scholar
  36. 36.
    Bagatin M, Der Sarkissian R, Larrabee Jr WF. Craniofacial manifestations of the amniotic band syndrome. Otolaryngol Head Neck Surg. 1997;116:525–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Coyle S, Karp JM, Shirakura A. Oral rehabilitation of a child with amniotic band syndrome. J Dent Child. 2008;75:74–9.Google Scholar
  38. 38.
    Taub PJ, Lin H, Silber L. Mandibular distraction for amniotic band syndrome in the neonate. Ann Plast Surg. 2007;59:334–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Taub PJ, Bradley JP, Setoguchi Y, Schimmenti L, Kawamoto Jr HK. Typical facial clefting and constriction band anomalies: an unusual association in three unrelated patients. Am J Med Genet. 2003;120A:256–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Nargozian C. The airway in patients with craniofacial abnormalities. Paediatr Anaesth. 2004;14:53–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Verchere S, Khalil B, Maddukuri V, Hagberg CA. Use of the DCI video laryngoscope system in a pediatric patient with amniotic band syndrome and craniofacial abnormalities affecting the airway. J Clin Anesth. 2012;24:151–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Shipster C, Hearst D, Dockrell JE, Kilby E, Hayward R. Speech and language skills and cognitive functioning in children with Apert syndrome: a pilot study. Int J Lang Commun Disord. 2002;37:325–43.PubMedCrossRefGoogle Scholar
  43. 43.
    Barnett S, Moloney C, Bingham R. Perioperative complications in children with Apert syndrome: a review of 509 anesthetics. Pediatr Anesth. 2011;21:72–7.CrossRefGoogle Scholar
  44. 44.
    Hemmer KM, McAlister WH, Marsh JL. Cervical spine anomalies in the craniosynostosis syndromes. Cleft Palate J. 1987;24(4): 328–33.PubMedGoogle Scholar
  45. 45.
    Sarimski K. Children with Apert syndrome: behavioural problems and family stress. Dev Med Child Neurol. 1998;40:44–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Nargozian C. Apert syndrome. Anesthetic management. Clin Plast Surg. 1991;18(2):227–30.PubMedGoogle Scholar
  47. 47.
    Lowe LH, Booth TN, Joglar JM, Rollins NK. Midface anomalies in children. Radiographics. 2000;20:907–22.PubMedCrossRefGoogle Scholar
  48. 48.
    Kasai T, Bradley TD. Obstructive sleep apnea and heart failure pathophysiologic and therapeutic implications. J Am Coll Cardiol. 2011;57(2):119–27.PubMedCrossRefGoogle Scholar
  49. 49.
    Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Findley LJ, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Suratt PM. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest. 1986;90(5):686–90.PubMedCrossRefGoogle Scholar
  51. 51.
    Koh JGH. Perioperative management of pediatric patients with craniosynostosis. Anesthesiol Clin. 2007;25(3):465–81.PubMedCrossRefGoogle Scholar
  52. 52.
    Zuckerberg AL, Yaster M. Anesthesia for orthopedic surgery. In: Davis PJ, editor. Smith’s anesthesia for infants and children. 8th ed. Philadelphia: Elsevier Mosby; 2011.Google Scholar
  53. 53.
    Bamshad M, Van Heest AE, Pleasure D. Arthrogryposis: a review and update. J Bone Joint Surg Am. 2009;91 Suppl 4:40–6.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Gornik-Wlaszczuk E, Majewski J, Szczygiel R, Kurak J. Anaesthesia in patients with arthrogryposis. Anestezjol Intens Ter. 2011;43(2):90–2.PubMedGoogle Scholar
  55. 55.
    Sreevastava D, Trikha A, Sehgal L, Arora MK. Interscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita. Anaesth Intensive Care. 2002;30: 495–8.PubMedGoogle Scholar
  56. 56.
    Ion T, Cook-Sather D, Finkel S, Cucchiaro G. Fascia iliaca block for an infant with arthrogryposis multiplex congenita undergoing muscle biopsy. Anesth Analg. 2005;100:82–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Nguyen NH, Morvant EM, Mayhew JF. Anesthetic management for patients with arthrgryposis multiplex congenita and severe micrognathia: case reports. J Clin Anesth. 2000;12:227–30.PubMedCrossRefGoogle Scholar
  58. 58.
    Oberoi GS, Kaul HL, Gill IS, Batra RK. Anaesthesia in arthrogryposis multiplex congenita: case report. Can J Anaesth. 1986;34(3):288–90.CrossRefGoogle Scholar
  59. 59.
    Lammers C, Wyckaert C. Anesthesia for orthopedic surgery. In: Gregory GA, Andropoulos DB, editors. Gregory’s pediatric anesthesia. 5th ed. Oxford: Wiley-Blackwell; 2012.Google Scholar
  60. 60.
    Zamudio IA, Brown TCK. Arthrogryposis multiplex congenita (AMC). A review of 32 years’ experience. Paediatr Anaesth. 1993;3:101–6.CrossRefGoogle Scholar
  61. 61.
    Oda Y, Yukioka H, Fujimori M. Anesthesia for arthrogryposis multiplex congenita. J Anesth. 1990;4(3):275–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Hopkins PM, Ellis FR, Halsall PJ. Hypermetabolism in arthrogryposis multiplex congenita. Anaesthesia. 1991;46:374–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Benca J, Hogan K. Malignant hyperthermia, coexisting disorders, and enzymopathies: risks and management options. Anesth Analg. 2009;109(4):1049–53.PubMedCrossRefGoogle Scholar
  64. 64.
    Dunn HG, Daube JR, Gomez MR. Heredofamilial branchial plexus neuropathy (hereditary neuralgic amyotrophy with branchial predilection) in childhood. Dev Med Child Neurol. 1978;20:28.PubMedCrossRefGoogle Scholar
  65. 65.
    Klein CJ, Barbara DW, Sprung J, Dyck PJ, Weingarten TN. Surgical and postpartum hereditary brachial plexus attacks and prophylactic immunotherapy. Muscle Nerve. 2013;47:23.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2006;129:438.PubMedCrossRefGoogle Scholar
  67. 67.
    Jeannet PY, Watts GD, Bird TD, Chance PF. Craniofacial and cutaneous findings expand the phenotype of hereditary neuralgic amyotrophy. Neurology. 2001;57:1963.PubMedCrossRefGoogle Scholar
  68. 68.
    Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90:1258.PubMedCrossRefGoogle Scholar
  69. 69.
    van Dijk JG, Pondaag W, Malessy MJ. Obstetric lesions of the brachial plexus. Muscle Nerve. 2001;24:1451.PubMedCrossRefGoogle Scholar
  70. 70.
    Wilbourn AJ. Plexopathies. Neurol Clin. 2007;25:139.PubMedCrossRefGoogle Scholar
  71. 71.
    Kawabata H, Masada K, Tsuyuguchi Y, Kawai H, Ono K, Tada R. Early microsurgical reconstruction in birth palsy. Clin Orthop Relat Res. 1987;215:233–42.PubMedGoogle Scholar
  72. 72.
    Walters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999;81: 649–59.Google Scholar
  73. 73.
    Capek L, Clarke HM, Curtis CG. Neuroma-in-continuity resection: early outcome in obstetrical brachial plexus palsy. Plast Reconstr Surg. 1998;102:1555–62.PubMedCrossRefGoogle Scholar
  74. 74.
    Hazama A, Kinouchi K, Kitamura S, Fukumitsu K. Brachial plexus birth injuries: anaesthesia for surgical nerve reconstruction and preoperative myelography and computed tomographic myelography. Paediatr Anaesth. 1999;9:403–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Herod J, Denyer J, Goldman A, Howard R. Epidermolysis bullosa in children: pathophysiology, anaesthesia and pain management. Paediatr Anaesth. 2002;12:388–97.PubMedCrossRefGoogle Scholar
  76. 76.
    James I, Wark H. Airway management during anesthesia in patients with epidermolysis bullosa dystrophica. Anesthesiology. 1982;56:323–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Milne JK, Rosales B. Anaesthesia for correction of oesophageal stricture in a patient with recessive epidermolysis bullosa dystrophica: case report. Can Anaesth Soc J. 1980;27(2):169–71.PubMedCrossRefGoogle Scholar
  78. 78.
    Kelly RE, Koff HD, Rothaus KO, Carter DM, Artusio JF. Brachial plexus anesthesia in eight patients with recessive dystrophic epidermolysis bullosa. Anesth Analg. 1987;66:1318–20.PubMedCrossRefGoogle Scholar
  79. 79.
    Holt M, Oram S. Familial heart disease with skeletal malformations. Br Heart J. 1960;22:236–42.PubMedCentralPubMedCrossRefGoogle Scholar
  80. 80.
    Basson CT, Cowley GS, Solomon SD, Weissman B, Poznanski AK, Traill TA, et al. The clinical and genetic spectrum of the Holt–Oram syndrome (heart–hand syndrome). N Engl J Med. 1994;331:885–91.CrossRefGoogle Scholar
  81. 81.
    Sletten LJ, Pierpont ME. Variation in severity of cardiac disease in Holt-Oram syndrome. Am J Med Genet. 1996;65:128–32.PubMedCrossRefGoogle Scholar
  82. 82.
    Newbury-Ecob RA, Leanage R, Raeburn JA, Young ID. Holt-Oram syndrome: a clinical genetic study. J Med Genet. 1996;33:300–7.PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Bissonnette B, Luginbuehl I, Marciniak B, Dalens B. Syndromes: rapid recognition and perioperative Implications. New York: McGraw Hill; 2006.Google Scholar
  84. 84.
    Bruneau BG, Logan M, Davis N, Levi T, Tabin CJ, Seidman JG, et al. Chamber-specific cardiac expression of Tbx5 and heart defects in Holt-Oram syndrome. Dev Biol. 1999;211:100–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Poznanski AK, Gall Jr JC, Stern AM. Skeletal manifestations of the Holt–Oram syndrome. Radiology. 1970;94:45–53.PubMedCrossRefGoogle Scholar
  86. 86.
    James MA, McCarroll Jr HR, Manske PR. Characteristics of patients with hypoplastic thumbs. J Hand Surg Am. 1996;21A: 104–13.CrossRefGoogle Scholar
  87. 87.
    Smith AT, Sack Jr GH, Taylor GJ. Holt–Oram syndrome. J Pediatr. 1979;95(4):538–43.PubMedCrossRefGoogle Scholar
  88. 88.
    Huang T. Current advances in Holt-Oram syndrome. Curr Opin Pediatr. 2002;14(6):691–5.PubMedCrossRefGoogle Scholar
  89. 89.
    Kevin P, David Jr CS. Disorders of sternum and the thoracic wall. 6th ed. Philadelphia: WB Saunders; 1995.Google Scholar
  90. 90.
    Poland A. Deficiency of the pectoral muscles. Guy’s Hosp Rep. 1841;6:191.Google Scholar
  91. 91.
    Bing R. Uber angeborene Muskeldefekte. Arch Path Anat Physiol Klin Med. 1902;170:175.CrossRefGoogle Scholar
  92. 92.
    Clarkson P. Poland’s syndactyly. Guy’s Hosp Rep. 1962;111:335–46.Google Scholar
  93. 93.
    Pearl M, Chow TF, Friedman E. Poland’s syndrome. Radiology. 1971;101(3):619–23.PubMedCrossRefGoogle Scholar
  94. 94.
    Bainbridge LC, Wright AR, Kanthan R. Computed tomography in the preoperative assessment of Poland’s syndrome. Br J Plast Surg. 1991;44(8):604–7.PubMedCrossRefGoogle Scholar
  95. 95.
    Mace JW, Kaplan KM, Schanberger JE, Gotlin RW. Poland’s syndrome: report of seven cases and review of the literature. Clin Pediatr. 1972;11(2):98–102.CrossRefGoogle Scholar
  96. 96.
    Martin LW, Helmsworth JA. The management of congenital deformities on the sternum. JAMA. 1962;179:82–4.PubMedCrossRefGoogle Scholar
  97. 97.
    Duncan P. Neuromuscular diseases. In: Katz J, Steward DJ, editors. Anesthesia and uncommon pediatric diseases. 2nd ed. Philadelphia: WB Saunders Co.; 1993.Google Scholar
  98. 98.
    Khatavkar SS, Jagtap SR. Anaesthetic management for cataract surgery in VACTERL syndrome case report. Indian J Anaesth. 2009;53(1):94–7.PubMedCentralPubMedGoogle Scholar
  99. 99.
    Maschke SD, Seitz W, Lawton J. Radial longitudinal deficiency. J Am Acad Orthop Surg. 2007;15(1):41–52.PubMedGoogle Scholar
  100. 100.
    Mariano ER, Chu LF, Albanese CT, Ramamoorthy C. Successful thoracoscopic repair of esophageal atresia with tracheoesophageal fistula in a newborn with single ventricle physiology. Anesth Analg. 2005;101:1000–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ann F. T. Lawrence
    • 1
  • Emily L. A. Stebbins
    • 1
  • Borzoo Farhang
    • 1
  1. 1.Department of AnesthesiologyThe University of Vermont College of Medicine/Fletcher Allen Health CareBurlingtonUSA

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