Epidural Anesthesia Combined with Light General Anesthesia for a Juvenile with Charcot-Marie-Tooth Disease Undergoing Corrective Spine Surgery: A Case Report

Zanjani, Amir Poya; Ghorbani, Azam; Eslami, Babak; Mirzashahi, Babak

doi:10.5812/aapm.14189

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…CMT patients often undergo corrective orthopedic procedures to address foot deformities and, as such, could potentially benefit from the regional blocks for postoperative analgesia. Despite relative contraindications to local anesthetics in demyelinating diseases, the successful use of epidural and spinal anesthesia has been described in several reports 67,69‐72 . Two instances of residual blockade following epidural use have been noted in the literature, but both resulted in full baseline neurological recovery without worsening of underlying disease at one month and six‐month follow‐ups 71,73 .…”

Section: Charcot Marie Toothmentioning

confidence: 99%

“…Two instances of residual blockade following epidural use have been noted in the literature, but both resulted in full baseline neurological recovery without worsening of underlying disease at one month and six‐month follow‐ups 71,73 . Effective use of peripheral nerve blocks has also been described 67‐72,74‐76 …”

Section: Charcot Marie Toothmentioning

confidence: 99%

“…Despite relative contraindications to local anesthetics in demyelinating diseases, the successful use of epidural and spinal anesthesia has been described in several reports. 67,[69][70][71][72] Two instances of residual blockade following epidural use have been noted in the literature, but both resulted in full baseline neurological recovery without worsening of underlying disease at one month and six-month follow-ups. 71,73 Effective use of peripheral nerve blocks has also been described.…”

Section: Regional Anesthesia and Cmtmentioning

confidence: 99%

“…71,73 Effective use of peripheral nerve blocks has also been described. [67][68][69][70][71][72][74][75][76] Like many of the aforementioned disease states, the current evidence regarding the safety profile of regional anesthesia use in patients with CMTD is sparse and does not allow for a definitive conclusion about its use in this population. One could presume that in a patient with advanced disease, completely lacking myelin, a peripheral nerve block using a high concentration of local anesthetic could theoretically cause harm and should be avoided.…”

Section: Regional Anesthesia and Cmtmentioning

confidence: 99%

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Regional anesthesia in pediatric patients with preexisting neurological disease

Cung

Ritz

Masaracchia

2021

Pediatric Anesthesia

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Preexisting neurological disease in pediatric patients presents unique challenges to the anesthesiologist. In‐depth knowledge of the disease processes and awareness of sequalae that uniquely influence the risks and benefits of anesthetics are needed to make informed decisions. Because these vulnerable populations are often susceptible to perioperative airway or cardiopulmonary complications, the use of regional anesthesia can be advantageous. However, these clinical conditions already involve compromised neural tissue and, as such, create additional concern that regional anesthesia may result in new or worsened deficits. The following discussion is not intended to be a full review of each disease process, but rather provides a concise, yet thorough, discussion of the available literature on regional anesthesia in the more common, but still rare, pediatric neurological disorders. We aim to provide a framework for pediatric anesthesiologists to reengage in a healthy discussion about the risks and benefits of utilizing regional anesthesia in this vulnerable population.

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Section: Charcot Marie Toothmentioning

confidence: 99%

Section: Charcot Marie Toothmentioning

confidence: 99%

Section: Regional Anesthesia and Cmtmentioning

confidence: 99%

Section: Regional Anesthesia and Cmtmentioning

confidence: 99%

See 2 more Smart Citations

Regional anesthesia in pediatric patients with preexisting neurological disease

Cung

Ritz

Masaracchia

2021

Pediatric Anesthesia

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“…Furthermore, because almost all CMT1A patients develop symptoms in childhood and adolescence, even if they are unaware of them, it is important to be conscious of the existence of a considerable number of undiagnosed adult patients. Early diagnosis may help to ensure the appropriateness of care including physical therapy (23) and avoid CMT-specific adverse events resulting from medications for other diseases (6)(7)(8)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Rate of Changes in CMT Neuropathy and Examination Scores in Japanese Adult CMT1A Patients

et al. 2020

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Introduction: We aimed to clarify when adult patients with Charcot-Marie-Tooth disease type 1A (CMT1A), especially those diagnosed at middle or advanced ages, first showed symptoms and whether the rate of disease progression is accelerated by aging. Methods: Medical records of CMT1A outpatients between 2012 and 2019 were reviewed. The age at diagnosis, age when symptoms first appeared, and rate of disease progression, assessed based on clinical outcome measures including the CMT Neuropathy Score (CMTNS), Rasch-modified CMTNS (CMTNS-R), CMT Examination Score (CMTES), and Rasch-modified CMTES (CMTES-R) were analyzed. Results: Among 45 adult CMT1A patients, 42% had been diagnosed after 50 years of age, whereas 91% of all patients had exhibited some CMT-related symptoms before 20 years of age. The annual increase of all clinical outcome measures did not differ between patients under and over 50 years. Even when limited to patients whose initial CMTES-R showed mild to moderate severity, the rate of change in CMTES-R did not differ between the two age groups (the annual mean ± standard deviation, under 50 years: 1.1 ± 1.0, and over 50 years: 0.9 ± 1.1, p = 0.68). To determine whether patients with disabilities at a young age have a higher deterioration rate, they were classified into three groups according to their current age and age at diagnosis: patients under 50 years of age, patients over 50 years of age but diagnosed before 50, and patients diagnosed after 50 years of age. The mean annual increase of all clinical outcome measures, however, did not differ among these groups (CMTES-R: 1.03 ± 1.01 vs. 0.94 ± 1.57 vs. 0.81 ± 0.88, respectively, p = 0.87). Discussion: CMT1A patients develop symptoms in childhood and adolescence even if such symptoms are not noticeable until reaching an advanced age. Deterioration rates of clinical outcome measures are constant irrespective of the age in their adulthood, although we cannot rule out the limitation that the difference did not reach significance because of the small number of patients. Being aware of the existence of a considerable number of undiagnosed CMT patients will help promote the avoidance of inadequate medication.

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Regional anesthesia in patients with Charcot–Marie–Tooth disease: a historical cohort study of 53 patients

McClain

Rubin

Bais

et al. 2022

Can J Anesth/J Can Anesth

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Purpose Anesthetic management for patients with Charcot-Marie-Tooth disease (CMT) is controversial. Description of the use of regional anesthesia (RA) in patients with CMT is limited. Regional anesthesia has traditionally been avoided because of risk of nerve injury. We retrospectively reviewed patients with CMT who received RA at our institution. Methods We performed a historical cohort study of all patients with CMT who received RA from 30 April 2010 to 30 April 2020 within our institution. Charts were reviewed for information on demographics, RA procedures, perioperative variables, evidence of neurologic complications, post-RA neurology consults, and perioperative electromyography (EMG) results. Electromyographs were reviewed by a neurologist who was blinded to the surgical and RA details. Results Fifty-three patients received a total of 132 regional anesthetics during the study period. Twenty-five patients received RA on more than one occasion. Fifty-five EMGs and 14 postoperative neurology consults were performed. Two patients had neurology consults with peripheral nerve block (PNB) distribution complaints years later. Neither attributed the complaints to the PNB. The other neurology consults were for unrelated complaints. No EMG results suggested injury related to PNB. Conclusion This study found no evidence of documented neurologic complications or an increased risk of nerve injury related to RA in CMT patients.

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Epidural Anesthesia Combined with Light General Anesthesia for a Juvenile with Charcot-Marie-Tooth Disease Undergoing Corrective Spine Surgery: A Case Report

Cited by 6 publications

References 12 publications

Regional anesthesia in pediatric patients with preexisting neurological disease

Regional anesthesia in pediatric patients with preexisting neurological disease

Rate of Changes in CMT Neuropathy and Examination Scores in Japanese Adult CMT1A Patients

Regional anesthesia in patients with Charcot–Marie–Tooth disease: a historical cohort study of 53 patients

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