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Institutional Variability in Anesthesia Time for Mehta Casting in Early-Onset Scoliosis (EOS).
Bonsignore-Opp, Lisa; Malka, Matan S; Ball, Jacob; Simhon, Matthew E; Matsumoto, Hiroko; Sturm, Peter; Pahys, Joshua M; Vitale, Michael G; Larson, A Noelle; Roye, Benjamin D.
Afiliación
  • Bonsignore-Opp L; Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
  • Malka MS; Department of Orthopedic Surgery, University of California, San Francisco, CA.
  • Ball J; Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
  • Simhon ME; Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
  • Matsumoto H; Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
  • Sturm P; Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital.
  • Pahys JM; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA.
  • Vitale MG; Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH.
  • Larson AN; Department of Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, PA.
  • Roye BD; Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
J Pediatr Orthop ; 44(5): 297-302, 2024.
Article en En | MEDLINE | ID: mdl-38353100
ABSTRACT

PURPOSE:

Mehta casting is a potentially curative intervention for early-onset scoliosis (EOS) that typically requires multiple anesthetics. The Food and Drug Administration (FDA) reported that >3 hours of anesthesia under the age of 3 years old may alter brain development; however, no standard exists for the duration of anesthesia during casting. The purpose of this study is to quantify the variability in anesthesia during Mehta casting. We hypothesize that significant institutional variability exists and may be attributed to modifiable factors.

METHODS:

An EOS registry was used to identify patients who underwent at least one Mehta casting procedure. Anesthesia exposure was quantified, and site variability was assessed by patient characteristics, cast placement, procedure type, and equipment used.

RESULTS:

Our cohort consisted of 208 patients from 5 institutions (age 2.6±1.4 y). There were 1097 Mehta casting procedures, with 5.4±3.6 castings per patient. Of these patients, 106 (51%) were female, with an average age of 2.11±1.29 years old at the time casting was initiated. Patient etiologies included 154 idiopathic (74.0%), 22 syndromic (10.6%), 18 congenital (8.7%), 11 neuromuscular (5.3%), and 3 unknown (1.4%). Anesthesia time was 69±31 minutes and varied significantly between sites (59±14 to 117±46 min; P <0.001). Cumulative anesthesia time for patients under 3 years was 320±197 minutes with 120/161 (74.5%) patients exceeding 3 hours. Anesthesia time was lower after the FDA warning in 2016 compared with pre-2016 (71±30 vs. 66±32, P =0.008).

CONCLUSIONS:

Patients undergoing Mehta casting are at significant risk of exceeding 3 hours of anesthesia, which the FDA has stated may be harmful for children <3 years. Significant site variability indicates that standardization protocols should be developed to encourage best practices and minimize anesthetic times. LEVEL OF EVIDENCE Prognostic Level II.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Escoliosis / Anestesia Tipo de estudio: Guideline / Prognostic_studies Límite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Orthop Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Escoliosis / Anestesia Tipo de estudio: Guideline / Prognostic_studies Límite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Orthop Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos