Anesthesia Use in Polio Survivors: What’s New?
Selma H. Calmes, MD, Chairman and Professor (retired), Anesthesiology Department,
Olive View/UCLA Medical Center, Sylmar, California, firstname.lastname@example.org
o we know anything new about anesthesia for polio survivors?
By reviewing reports in medical journals we find that in the
last two years, 2008-2010, there were five case reports (each
about a single post-polio patient having anesthesia) in the medical
literature and one study of a group. We will look at useful aspects
of these cases and also comment on two other aspects of anesthesia
care that are important.
Three of the five case reports were anatomy before trying spinal anesthe-
about regional anesthesia (RA). Re- sia. Both techniques helped the anes-
gional anesthesia means that a local thesiologists know where to place the
anesthesia drug, such as lidocaine, is needle for local anesthesia successful-
Selma H. Calmes, MD, is a polio injected to numb nerves in the back ly and easily. The third case report on
survivor and a member of PHI’s (spinal or epidural) or other body loca- regional anesthesia was about a nerve
board of directors.
tions such as arms or legs (various block of the leg for postoperative pain
nerve blocks). It is very safe and is relief after surgery on that leg.
preferred to general anesthesia, be- The group study was from Brazil and
cause it blocks the pain signals coming reported on 123 patients having 162
from the surgery site to the brain. This operations, mostly orthopedic surgery.
is very favorable for patients’ well- Mean patient age was young – 35
being. However, some operations can’t years, and only three patients had
be done with regional anesthesia. It serious medical diseases in addition
is often technically hard to do RA in to having had polio. Regional anes-
post-polio patients with scoliosis, espe- thesia was used for 64 percent of
cially if Harrington rods are present. patients. No significant anesthesia
There is a new tool to help place RA: complications occurred. These patients
portable ultrasound (US) devices that were followed for 22 months postop-
help anesthesiologists find exactly eratively, and there was no change in
where to administer the anesthesia neurologic status.
drug. This technique is now commonly This study documents that young
used in the United States, especially in post-polio patients do well during
teaching hospitals. One of the five cases anesthesia, especially with RA. How-
was the first to report using US to ever, American patients are much
place a spinal anesthetic in a post-polio older, in their 70s and 80s, and so
patient with Harrington rods. Another also have diseases of aging, such as
case of regional anesthesia involved heart disease, diabetes and hyperten-
severe scoliosis and reported using a sion, all significant for anesthesia risk.
computed tomography (CT) scan to
look at a post-polio patient’s back continued, page 3
INFORMATION FROM POST-POLIO HEALTH INTERNATIONAL, SAINT LOUIS, MISSOURI, USA
Anesthesia Use in Polio Survivors: What’s New?
continued from page 1
Often, these diseases of aging are gist needs to be involved in the
much more important than any postop care.
post-polio issues. So, we still need Sleep apnea is common in post-
a large group study of the U.S. polio patients, and many need
polio population during anesthesia. CPAP/BiPAP devices. Sleep apnea
What do we learn from these is well-documented to be a risk
reports? First, this is increasing factor for anesthesia incidents,
evidence that RA can be safely both at the beginning of anes-
used in post-polio patients. And, thesia and, especially, at the end
so far, there is no evidence that of the case as patients begin to
PPS gets worse after RA. (This had breathe on their own. Useful
been a concern after inflammatory guidelines are in place to improve
proteins were found in the spinal safety during anesthesia. Patients Anesthesiologists at their annual meeting
fluid of some post-polio patients.) with sleep apnea, especially those learn how to use ultrasound to place a
Technical difficulties can be over- ,
on CPAP/BiPAP should let the nerve block of the arm or shoulder.
come by using US or CT imaging. surgeons know this early in the Photo by Steve Donisch courtesy of the American
Society of Anesthesiologists
Also, regional anesthesia can safe- surgery scheduling process, so
ly be used for postop pain relief. they can alert everyone on the
So polio patients can experience surgical team. Patients should
the many benefits of modern bring their CPAP devices to the
anesthesia care! hospital and, after the breathing
The importance of two other as- tube is removed, CPAP should
pects of anesthesia care for post- begin. This requires someone
polio patients is becoming clearer: to set up the machine, usually a
the need for preoperative pul- respiratory therapist. If regional
monary function tests and sleep anesthesia is used, the CPAP
apnea issues. Respiratory muscle device can even be used during
function gets worse as we age, the procedure, although not all For more information on anesthesia:
especially for those who had polio. anesthesiologists are comfortable
with this. Recommendations: www.post-
It is important to know what a polio.org/edu/hpros/sum-anes.html
particular patient’s pulmonary Should we make any changes in
Anesthesia update. Separating fact
status is before most operations, the present recommendations for from fear: www.post-polio.org/
especially upper abdominal or anesthesia for polio survivors? net/10thConfAnesthesiaCalmes.pdf
chest operations. This is measured Regional anesthesia appears to be
with pulmonary function tests safe for post-polio patients, and Sleep apnea issues: www.post-
(PFTs) by a pulmonary physician. the benefits – in terms of pain
Those who used iron lungs should relief and anesthesia safety – are
definitely have preop PFTs, because worth a possible small risk. So, Lambert DA et al. Postpolio
they seem to be at higher risk for the recommendations stand as is. syndrome and anesthesia.
postop respiratory failure. Lung It is essential to realize that the Anesthesiology 2005; 103:638-644
function should be optimized by recommendations are not based
treating any infection, controlling on actual data; there is no signifi-
bronchospasm and assisting cough- cant data yet about how polio
ing before high-risk patients have patients actually do during anes-
major surgery, and a pulmonolo- thesia. See the sidebar for other
resources about anesthesia. s
www.post-polio.org POST-POLIO HEALTH Spring 2011 Vol. 27, No. 2 3