Risk factors for perioperative adverse events in children with myotonic dystrophy.
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.
Sinclair
Joanna L
JL
Department of Paediatric Anaesthesia, Starship Children's Hospital, Private Bag 92024, Auckland Mail Centre, Auckland 1142, New Zealand. owenandjo@yahoo.co.uk
Reed
Peter W
PW
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D015233:Models, Statistical; D009020:Morphine / Q000627:therapeutic use; D009223:Myotonic Dystrophy / Q000150:complications*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009465:Neuromuscular Agents; D009020:Morphine