PMID- 19624361
OWN - NLM
STAT- MEDLINE
DCOM- 20091022
LR  - 20181201
IS  - 1460-9592 (Electronic)
IS  - 1155-5645 (Linking)
VI  - 19
IP  - 8
DP  - 2009 Aug
TI  - Risk factors for perioperative adverse events in children with myotonic 
      dystrophy.
PG  - 740-7
LID - 10.1111/j.1460-9592.2009.03079.x [doi]
AB  - BACKGROUND: This study was conducted to identify patient-related, surgical, and 
      anesthetic factors that would help predict adverse events and allow for better 
      planning of perioperative care in children with myotonic dystrophy. METHODS: This 
      is a retrospective chart review from a large tertiary pediatric hospital. Data 
      were collected on demographics, disease severity, surgical procedure, and 
      anesthetic technique. Perioperative adverse events were recorded. RESULTS: 
      Records on 27 patients having 78 anesthetics over a 17.5-year period were 
      reviewed. The overall frequency of postoperative respiratory complications was 
      10%. Significant risk factors were high muscular impairment rating scale (MIRS) 
      grade (P = 0.007), at least 2300 cytosine, thymine, guanine (CTG) repeats on the 
      protein kinase gene of chromosome 19q (P = 0.009), a longer duration of surgery 
      (RR = 14.0 for surgery lasting at least 1 h; P = 0.002), perioperative morphine 
      use (RR = 7.7, 95% CI 2.2-12.8; P = 0.005), intubation (P = 0.02), and the use of 
      muscle relaxant without reversal (RR = 15.5, P = 0.0002). Using a multivariate 
      risk model, only MIRS grade and the use of muscle relaxant without reversal were 
      shown to be significant independent risk factors (RR = 24.9, P < 0.0001). 
      CONCLUSIONS: The MIRS is a statistically significant and clinically useful tool 
      for predicting high perioperative risk. Patients with a high MIRS grade should 
      therefore be considered for postoperative intensive care. The use of muscle 
      relaxant without reversal was also shown to be a significant risk factor. 
      Patients who require morphine infusions postoperatively might also be most safely 
      managed in a high dependency unit.
FAU - Sinclair, Joanna L
AU  - Sinclair JL
AD  - Department of Paediatric Anaesthesia, Starship Children's Hospital, Private Bag 
      92024, Auckland Mail Centre, Auckland 1142, New Zealand. owenandjo@yahoo.co.uk
FAU - Reed, Peter W
AU  - Reed PW
LA  - eng
PT  - Journal Article
PL  - France
TA  - Paediatr Anaesth
JT  - Paediatric anaesthesia
JID - 9206575
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Neuromuscular Agents)
RN  - 76I7G6D29C (Morphine)
SB  - IM
MH  - Adolescent
MH  - Analgesics, Opioid/therapeutic use
MH  - Anesthesia, Conduction/adverse effects/methods
MH  - Anesthesia, General/adverse effects/methods
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Infant
MH  - Intraoperative Complications/*etiology
MH  - Male
MH  - *Models, Statistical
MH  - Morphine/therapeutic use
MH  - Myotonic Dystrophy/*complications
MH  - Neuromuscular Agents/therapeutic use
MH  - Postoperative Complications/*etiology
MH  - Respiration, Artificial/statistics & numerical data
MH  - Respiratory Insufficiency/epidemiology/etiology/therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2009/07/25 09:00
MHDA- 2009/10/23 06:00
CRDT- 2009/07/24 09:00
PHST- 2009/07/24 09:00 [entrez]
PHST- 2009/07/25 09:00 [pubmed]
PHST- 2009/10/23 06:00 [medline]
AID - PAN3079 [pii]
AID - 10.1111/j.1460-9592.2009.03079.x [doi]
PST - ppublish
SO  - Paediatr Anaesth. 2009 Aug;19(8):740-7. doi: 10.1111/j.1460-9592.2009.03079.x.