Postpolio Syndrome and Anesthesia

Abstract

The development of polio vaccines 50 yr ago essentially halted childhood polio epidemics in the industrialized world. During the past quarter century, a constellation of delayed neuromuscular symptoms, called postpolio syndrome, became recognized among the aging polio survivors. The prevalence of postpolio syndrome in the U.S. population is estimated to be in the hundreds of thousands. The most common symptoms are fatigue, pain, and new onset weakness thought to be related to delayed deterioration of motor neuron function. When a patient with postpolio syndrome presents for surgery, special precautions are warranted, because these patients may have respiratory impairment, sleep apnea, swallowing difficulties, and cold intolerance. This article first reviews clinical features and some pathoetiologic theories of postpolio syndrome and then focuses on anesthetic considerations including the use of common anesthetics, neuromuscular blockade, regional anesthesia, and general anesthetic management strategies.

Anaesthesia for Coronary Artery Bypass Grafting in Post Poliomyelitis Syndrome: 2 Case Reports and Literature Review

“…In addition to that, 40% of PPS patients have some degree of respiratory dysfunction. [1] Emergence from anaesthesia is thus, the period where utmost caution has to be exerted. Two of the case reports [5,7] available and mentioned earlier have reported unanticipated postoperative respiratory failure, one of them reporting a cardiopulmonary arrest one hour postoperatively where the patient could not be revived.…”

“…Along with limb paralysis, these patients also frequently present with spinal curvature deformities of varied degrees at different levels of the spine. [1] A study carried out in 2003, [2] reported poliomyelitis infection survivors, to have a high incidence of dyslipidemia and a high prevalence of two or more coronary artery disease risk factors. With advancing age, this population, of the past century, now frequently presents to us for elective cardiac or emergency cardiac surgical procedures.…”

Cesarean delivery under ultrasound-guided spinal anesthesia, in a parturient with poliomyelitis and Harrington instumentation

“…The most common symptoms are fatigue, pain, and new onset weakness thought to be related to a delayed deterioration of the motor neuron function. 8,9 Female survivors of polio have an elevated risk for pregnancy complications, operative delivery, and adverse perinatal outcomes. 10,11 Veiby et al 10 noted that pre-eclampsia was significantly more frequent in patients with poliomyelitis, irrespective of maternal age or parity.…”

Anesthesia for craniotomy in a patient with previous paralytic polio

“…This situation has been described as the postpolio syndrome [1,2]. Patients having this disorder have excessive susceptibility to neuromuscular blockers [2,3]. We report the case of a patient who had no evidence of postpolio syndrome, but nevertheless showed excessive sensitivity to nondepolarizing muscle relaxants, and developed weakness while in the intensive care unit (ICU).…”

“…Such polio survivors can develop new onset of progressive muscle weakness and fatigue in skeletal or bulbar muscles more than 15 years later. This situation has been described as the postpolio syndrome [1,2]. Patients having this disorder have excessive susceptibility to neuromuscular blockers [2,3].…”