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Lao HC, Lin YC, Liang ML, Yang YW, Huang YH, Chan YL, Hsu YW, Lin SP, Chuang CK, Cheng JK, Lin HY. The Anesthetic Strategy for Patients with Mucopolysaccharidoses: A Retrospective Cohort Study. J Pers Med 2022; 12:jpm12081343. [PMID: 36013292 PMCID: PMC9410098 DOI: 10.3390/jpm12081343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Anesthesia for patients with mucopolysaccharidoses (MPS) is quite challenging due to vital systemic dysfunction following progressive accumulation of lysosomal glycosaminoglycans. Previous studies focused on perioperative difficult airway management under general anesthesia but rarely depicted the concern of choosing the size of the endotracheal tube (ETT) as well as neuraxial anesthesia. This study aimed to analyze the overall anesthetic management and related complications for a thorough anesthetic strategy. Within the study period from 2002 to 2021, each record of the anesthetic and perioperative quality assurance/improvement system for patients with a diagnosis of MPS at MacKay Memorial Hospital was retrospectively reviewed. A total of 51 individuals with 151 anesthesia for 163 interventions were cohort studied, and there were 136 general anesthesia and 15 neuraxial anesthesia. We found that the most common interventions for MPS patients were otolaryngological surgeries (49.6%). Additionally, a secured airway played a marked preference for the most general anesthesia (87.1%). The incidence of difficult intubation was 12.5%. In view of ETT size, a smaller than estimated size was used in MPS type II, III, IV, and VI patients and also in patients who received intubation with multiple attempts. However, a larger than estimated size of ETT was adopted whilst choosing cuffed ones. For neuraxial anesthesia, two failed spinal anesthesia procedures were converted to general anesthesia and 73 percent of the patients received perioperative sedation. In conclusion, through the individualized anesthetic strategy and build-up of an experienced team for airway management, high-quality anesthesia can be ensured in each patient.
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Affiliation(s)
- Hsuan-Chih Lao
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11203, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Muh-Lii Liang
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei City 104217, Taiwan
| | - Ying-Wei Yang
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Ya-Hsien Huang
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Ying-Lun Chan
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Yung-Wei Hsu
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Shuan-Pei Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan
- College of Medicine, Fu-Jen Catholic University, Taipei 24205, Taiwan
| | - Jen-Kun Cheng
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Correspondence: (J.-K.C.); (H.-Y.L.); Tel.: +886-975-835-531 (J.-K.C.); +886-2-2543-3535 (ext. 3089 or 3090) (H.-Y.L.)
| | - Hsiang-Yu Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: (J.-K.C.); (H.-Y.L.); Tel.: +886-975-835-531 (J.-K.C.); +886-2-2543-3535 (ext. 3089 or 3090) (H.-Y.L.)
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