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PERIOPERATIVE MANAGEMENT OF CHILDREN WITH NEUROMUSCULAR DISORDERS: PROSPECTIVE STUDY
  • +12
  • Fabrizio Racca,
  • Yaroslava Longhitano,
  • Andrea Wolfer,
  • Fabio Carfagna,
  • Claudia Grattarola,
  • Paola Serio,
  • Fabio Sbaraglia,
  • Angela Amigoni,
  • Fabio Savron,
  • Fabio Caramelli,
  • Luigi Montagnini,
  • christian zanza,
  • Marinella Astuto,
  • Elisa Gallo,
  • Rosanna Vaschetto
Fabrizio Racca
Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo
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Yaroslava Longhitano
Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo
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Andrea Wolfer
Vittore Buzzi Children’s Hospital,
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Fabio Carfagna
University of Eastern Piedmont Amedeo Avogadro School of Medicine
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Claudia Grattarola
Istituto Giannina Gaslini
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Paola Serio
Meyer Children Hospital
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Fabio Sbaraglia
Policlinico Universitario Agostino Gemelli
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Angela Amigoni
University Hospital of Padova
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Fabio Savron
Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”
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Fabio Caramelli
University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic
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Luigi Montagnini
Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo
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christian zanza
MICHELE AND PIETRO FERRERO HOSPITAL
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Marinella Astuto
University Hospital Vittorio Emanuele Catania Polyclinic
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Elisa Gallo
University of Eastern Piedmont Amedeo Avogadro School of Medicine
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Rosanna Vaschetto
University of Eastern Piedmont Amedeo Avogadro School of Medicine
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Abstract

Background: Children with neuromuscular diseases (NMDs) often display altered vital functions mainly respiratory muscle weakness which increase the risk of postoperative pulmonary complications after general anesthesia or sedation. Non-invasive ventilation (NIV) associated with cough assistance can successfully reduce these complications. The aim of this study was to report our experience with a peri-operative protocol that consists in using NIV combined with mechanical insufflation-exsufflation (MI-E) to improve the postoperative outcome of children with NMD. Methods: To this end, we conducted a multicenter, observational study on consecutive pediatric patients with NMDs undergoing anesthesia or sedation for surgical and diagnostic procedures from December 2015 to December 2018 in 13 Italian hospitals. Results: We found that 89% of the 167 children included in the study (mean age 8 y), were at risk of respiratory complications, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative technology dependence, while 25% displayed severe dysphagia. Average hospital length of stay (LOS) was 12 (±17) days. Despite the complexity of these children, only 26 patients developed intraoperative surgical complications, whereas 14 developed postoperative respiratory complications. No patient needed tracheostomy. The occurrence of long-term mechanical ventilation (MV), severe scoliosis or dysphagia in the preoperative period and the use of cough assistance or invasive MV (IMV) longer than 24 h in the postoperative period were all associated with prolonged hospital LOS. Conclusion: A carefully planned, multidisciplinary approach for the perioperative management of pediatric NMD patients can help prevent and resolve postoperative complications.