Anaesthesia and airway management in mucopolysaccharidosis

Abstract This paper provides a detailed overview and dis-cussion of anaesthesia in patients with mucopolysacchari-dosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical mani-festations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardio-vascular manifestations poses a high anaesthetic risk to these patients. Typical anaesthetic problems include airway obstruction after induction or extubation, intubation diffi-culties or failure [can’t intubate, can’t ventilate (CICV)], possible emergency tracheostomy and cardiovascular and cervical spine issues. Because of the high anaesthetic risk, the benefits of a procedure in patients with MPS shoul

Acute postoperative opioid consumption trajectories and long-term outcomes in pediatric patients after spine surgery

Mandy MJ Li,1,2 Don Daniel Ocay,2,3 Alisson R Teles,2,4 Pablo M Ingelmo,5,6 Jean A Ouellet,1–2,7 M Gabrielle Pagé,8,9 Catherine E Ferland2,4–6,101Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 2Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada; 3Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; 4Integrated Program in Neurosciences, McGill University, Montreal, Quebec, Canada; 5Chronic Pain Services, Montreal Children’s Hospital, Montreal, Quebec, Canada; 6Department of Anesthesia, McGill University, Montreal, Quebec, Canada; 7Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada; 8Département d’anesthésiologie, Université de Montréal, Montreal, Quebec, Canada; 9Carrefour de l’innovation et de l’évaluation en santé, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada; 10Child Health and Human Development Research Axis, Research Institute-McGill University Health Centre, Montreal, Quebec, CanadaBackground: The days following surgery are a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid consumption trajectories in the acute postoperative period, identify predictors of trajectory membership and determine associations between opioid consumption trajectories and long-term patient outcomes.Materials and methods: Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were scheduled for spinal fusion surgery. Cumulative 6-hr opioid consumption was recorded for up to 5 days after spinal surgery. At 6 months after surgery, medication use, pain and functional activity were evaluated. Growth mixture modeling was used to identify opioid trajectories.Results: One hundred and six patients were included in the study. Mean cumulative 6-hr opioid consumption in the acute postoperative period was 13.23±5.20 mg/kg. The model with the best fit contained 5 acute postoperative trajectories and a quadratic term (AIC =6703.26, BIC =6767.19). Two types of patient behaviors were identified: high opioid consumers (trajectories 4 and 5) and low opioid consumers (trajectories 1, 2 and 3). Intraoperative intrathecal morphine dose was a predictor of trajectory membership (p=0.0498). Opioid consumption during the acute postoperative period was not significantly associated with pain, functional activity or pain medication use at 6 months after surgery.Conclusion: In pediatric patients, intraoperative intrathecal morphine dose predicts opioid consumption in the acute postoperative period. Importantly, opioid consumption during this period does not affect long-term outcomes in pediatric patients after a spine surgery.Keywords: opioids, pediatrics, postsurgical pain, trajectories, adolescent idiopathic scoliosis, spinal fusion surger