Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity Surgery

Luhmann, Scott J.; Furdock, Ryan

doi:10.1016/j.jspd.2018.05.005

Cited by 22 publications

(26 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although most of the literature on PRC focus on adult patients, understanding this population’s perioperative risk factors, presentation and outcome can, in many cases, aid in and be applicable to the pediatric population. Understanding the perioperative risk factors for PRCs can provide an invaluable opportunity to create and deploy targeted interventions to reduce perioperative morbidity and mortality [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

View full text Add to dashboard Cite

There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.

show abstract

Section: Introductionmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

View full text Add to dashboard Cite

show abstract

“…Rigid kyphosis in spinal deformities in patients with MMC seriously complicates their lives. Early treatment always causes easy correction of the deformity and leads to less surgical morbidity in these patients [14]. Especially, since lung development continues until the age of eight post-birth, the progression of kyphosis and scoliosis associated with kyphosis will cause lung problems in these patients in the future and will lead to a more difficult surgical recovery [15].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele

et al. 2020

View full text Add to dashboard Cite

Background The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. Methods Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients’ pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. Results The mean patient age was 6.9 (4–10) years. Mean preoperative kyphosis was 115° (87–166°), mean early postoperative kyphosis was 3.9° (20–10°), and final follow-up postoperative kyphosis was 5.1° (22–8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115–35°) preoperative, as 12.9° (32–0°) early postoperative, and 15.7° (34–0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1–T12 and T1–S1, respectively. Conclusion Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. Level of evidence Level 4

show abstract

“…Therefore, perioperative intensive lung care is essential for improving surgical outcome. The previous study suggests a perioperative protocol for optimizing respiratory function 7) . Preoperatively, it is recommended to start regimen, including percussion vest therapy, cough assist, an increase in nebulizer treatments, and frequent suctioning.…”

Section: Discussionmentioning

confidence: 99%

“…The association between tracheostomy presence and postoperative pneumonia has been reported 3,6) . The previous study reported the association of gastrostomy tube and respiratory complications 7) . The presence of a gastrostomy was a risk factor of respiratory complications after spinal deformity surgery in NSD patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Critical Care in Patient with Neuromuscular Cervicothoracic Kyphosis

Hong

Jung

Hyun

et al. 2019

J Neurointensive Care

View full text Add to dashboard Cite

A 10-year-old boy had a neuromuscular cervicothoracic kyphosis and kyphotic deformity got worse as he grew. He underwent posterior spinal fusion from T6 to pelvis two years ago. However, kyphosis progressed gradually, and difficulty occurred in breathing with a ventilator. We perform deformity correction with vertebral column resection at T5 and posterior fixation from T2 to T9 and posterior onlay fusion. Surgical correction is offered to stop the kyphosis progression, and finally to maintain the airway. After surgery, the patient transferred to an intensive care unit for respiratory care. The patient's breathing was much better than before surgery, and the patient was transferred to the general ward. We report the importance of postoperative care in spinal deformity patient with respiratory distress.

show abstract

Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity Surgery

Cited by 22 publications

References 15 publications

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele

Critical Care in Patient with Neuromuscular Cervicothoracic Kyphosis

Contact Info

Product

Resources

About