title: Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants with idiopathic clubfoot.
abstract: BACKGROUND
  Most patients with idiopathic clubfeet require a percutaneous tendoachilles tenotomy to correct residual equinus deformity. This procedure is typically performed with the child awake in an outpatient setting. Percutaneous tendoachilles tenotomy under general anesthesia offers the potential advantages of better pain control, the ability to perform the procedure in a more controlled manner, and the possibility of lessening the pain response of the infant. Potential disadvantages include concerns regarding the safety of general anesthesia in infants. The purpose of this study is to review the safety of this procedure performed in the operating room under general anesthesia.
  
  
  METHODS
  A retrospective review was carried out of patients with idiopathic clubfoot less than 1 year of age who underwent percutaneous tendoachilles tenotomy under general anesthesia from 2000 to 2008. Patient medical records were reviewed for gestational age, age at surgery, risk factors for anesthesia, and surgical/anesthesia-related complications. To be discharged on the day of surgery, patients met the accepted criteria. Children at risk for apnea were considered for overnight observation using established criteria of postconception age under 44 weeks, premature birth, pulmonary comorbidities, and history of an apneic event.
  
  
  RESULTS
  One hundred and thirty-seven patients underwent a total of 182 tenotomies under general anesthesia. Ninety-two tenotomies were unilateral, 45 were bilateral. The average postconception age at time of surgery was 53.9 weeks (range, 41 to 90 wk, SD 9.8 wk). Eighty-nine patients were under 3 months of age. Twenty-one patients (15.3%) met the criteria for the observation for postoperative monitoring for apnea because of postconception age under 44 weeks or gestational age under 37 weeks. Three patients were admitted overnight because of a maternal history of drug abuse. No patients had earlier apneic events or were American Society of Anesthesiologists Class III for comorbidities. No patient showed apnea or anesthesia-related complications.
  
  
  CONCLUSIONS
  Percutaneous tendoachilles tenotomy under general anesthesia can be safely performed in infants with clubfeet. No complications related to anesthesia were identified in this group and nearly all patients were discharged on the day of surgery.
  
  
  METHODS
  Prognostic level 3.
authors.affiliation: Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA. stephen.parada@us.army.mil
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Parada
authors.forename: Glen O
authors.initials: GO
authors.lastname: Baird
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Auffant
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Tompkins
authors.forename: Paul M
authors.initials: PM
authors.lastname: Caskey
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000768:Anesthesia, General; D002985:Clinical Protocols; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D019637:Orthopedic Procedures; D018579:Patient Selection; D012189:Retrospective Studies