Anesthetic and perioperative risk in the patient with Ataxia-Telangiectasia

Authors

  • Justin L. Lockman,

    1.  Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • Andrew J. Iskander,

    1.  Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • Melania Bembea,

    1.  Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
    2.  Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • Thomas O. Crawford,

    1.  Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA
    2.  Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • Howard M. Lederman,

    1.  Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • Sharon McGrath-Morrow,

    1.  Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA
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  • R. Blaine Easley

    1.  Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
    2.  Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA
    3.  Departments of Anesthesiology and Pediatrics, Texas Children’s Hospital, Houston, TX, USA
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  • Section Editor: Brian Anderson

R. Blaine Easley, Texas Children’s Hospital, 6621 Fannin, WT 17-417B, Houston, TX 77030, USA
Email: rbeasley@texaschildrens.org

Summary

Objectives/Aim:  To report our relatively large experience with perioperative care for patients with Ataxia-Telangiectasia (A-T) and to identify the nature and frequency of complications.

Background:  Ataxia-Telangiectasia is a rare autosomal recessive genetic disorder resulting in progressive multisystem degeneration and characteristic findings including complex neurodegeneration, immunodeficiency, increased risk of malignancy, and lung disease. Anecdotal reports have suggested high perioperative morbidity in patients with A-T, but few data exist.

Methods/Materials:  The Ataxia-Telangiectasia Clinical Center database was cross-referenced with operative records between 1995 and 2009 to identify patients with perioperative A-T, and medical records were reviewed for preoperative history, management techniques, and complications.

Results:  Twenty-one patients with A-T underwent 34 anesthetics during the study period. The median age was 12.5 years (range 6–33 years). Common comorbidities included neurologic (100%), pulmonary (68%), immunologic (50%), oncologic (47%), and gastroenterologic (35%) disorders. Supplemental oxygen was required on postanesthesia care unit discharge for 24% of patients with a maximal duration of 24 h. Although mild postoperative hypothermia was relatively common (44% of anesthetics), there were no major complications, no unplanned admissions, and no mortality in this series.

Conclusions:  Although limited by its retrospective nature, this is the first series describing perioperative risk for patients with A-T. Our results indicate that general anesthesia, airway manipulation, and perioperative mechanical ventilation may be tolerated with only minor postoperative anesthetic concerns. Perioperative providers should be aware of the complex multisystem medical concerns that may arise in these patients.

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