Ozan Ali ERDAL, Baris GORGUN, Sema ERTAN BİRSEL, İlker Abdullah SARIKAYA, Feryal BİÇER TÜRKMENOĞLU, Elif DİLER ERMEÇ, Ozlem KAYA, Muharrem INAN

Serebral Palsili Çocuklara Sevofluran İnhalasyon Anestezisi Altında Botulinum Toksin Uygulamalarında Klinik Sonuçlarımız

Amaç: Botulinum nörotoksini (BoNT-A) intramusküler enjeksiyonu, serebral palside (CP) görülen spastisitelerin tedavisinde kullanımı güvenli ve güvenilir olan bir araçtır. Lokal anestezi altında uygulaması yapılabilse de çoğu klinisyen, özellikle çocuk hastalar için, uygulamaların ameliyathanede genel anestezi altında yapılmasını tercih etmektedir. Bu çalışmanın amacı, CP tanılı çocuklarda BoNT-A enjeksiyonunlarının maske ile sevofluran kullanılarak uygulanan inhalasyon anestezisi altında yapılmasının güvenliğini ve etkinliğini değerlendirmektir. Gereç ve Yöntemler: Sevofluran kullanılarak maske ile inhalasyon anestezi altında BoNT-A enjeksiyonu yapılmış 61 çocuğun dosyası retrospektif olarak incelenmiştir. Anestezi işleminin başlamasından prosedürün sonuna kadar olan süreler kaydedilerek değerlendirildi. Kas başına BoNT-A dozu her bir kas için alt ekstremitede 3-6 IU/kg, üst ekstremitede için 1-3 IU/kg olarak uygulanmıştır. Bulgular: Hastaların ortalama yaşı 42 ay iken ortalama işlem süresi 15 dakika idi. Hastalarda anestezi işlemi ya da BoNT-A uygulamasına bağlı herhangi bir komplikasyon yaşanmamıştır. Sonuç: Bu çalışmada, CP tanılı çocuklarda yapılan BoNT-A enjeksiyonlarının sevofluran kullanılarak genel anestezi altında uygulanmasının güvenli ve etkin bir yöntem olduğu gösterilmiştir.

Anahtar Kelimeler:

Botulinum toksin, serebral palsi, inhalasyon anestezisi, sevofluran

Clinical Results of Sevoflurane Inhalation Anesthesia for Botulinum Neurotoxin Treatment in Children with Cerebral Palsy

Objective: The botulinum neurotoxin type A (BoNT-A) intramuscular injection is a safe and reliable method to treat increased spasticity in spastic cerebral palsy (CP). Although BNT-A injections may be administered under local anesthesia, many clinicians prefer injections under general anesthesia in the operating room, especially for children. The purpose of the present study was to evaluate the safety and efficacy of administering BNT-A injections to children with spastic CP under sevoflurane mask anesthesia. Materials and Methods: Files of 61 children with CP who received 191 BoNT-A injections under sevoflurane mask anesthesia were analyzed retrospectively. The time from the beginning of anesthesia to the end of the procedure was recorded. The BNT-A dose per muscle was 3–6 IU/kg body weight for lower extremity muscles and 1–3 IU/kg body weight for upper extremity muscles. Results: The mean age of the children was 42 months. The mean procedure time was 15 min. There were no complications related to anesthesia or the BTN-A injection procedure. Conclusion: BTN-A injections in children with spastic CP may be safely and effectively administered under sevoflurane mask anesthesia without any procedural or anesthetic complications.

Keywords:

Botulinum toxin, cerebral palsy, inhalation anesthesia, sevoflurane,

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1. Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47(8):571-576. doi:10.1017/S001216220500112X
2. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;49(SUPPL. 2):8-14. doi:10.1111/j.1469-8749.2007.tb12610.x
3. Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral Palsy Epidemiology: Where are We Now and Where are We Going? Dev Med Child Neurol. 2008;34(6):547-551. doi:10.1111/j.1469-8749.1992.tb11479.x
4. Dietz V, Sinkjaer T. Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurol. 2007;6(8):725-733. doi:10.1016/S1474-4422(07)70193-X
5. Warnink-Kavelaars J, Vermeulen RJ, Buizer AI, Becher JG. Botulinum neurotoxin treatment in children with cerebral palsy: validation of a needle placement protocol using passive muscle stretching and relaxing. Dev Med Child Neurol. 2016;58(12):1281-1287. doi:10.1111/dmcn.13176
6. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society, Delgado MR, Hirtz D, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child. Neurology. 2010;74(4):336-343. doi:10.1212/WNL.0b013e3181cbcd2f
7. Heinen F, Desloovere K, Schroeder AS, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010;14(1):45-66. doi:10.1016/j.ejpn.2009.09.005
8. Lin Y-C, Lin I-L, Chou T-FA, Lee H-M. Quantitative evaluation for spasticity of calf muscle after botulinum toxin injection in patients with cerebral palsy: a pilot study. J Neuroeng Rehabil. 2016;13(1):25. doi:10.1186/s12984-016-0135-8
9. Hoare B. Rationale for Using Botulinum Toxin A as an Adjunct to Upper Limb Rehabilitation in Children With Cerebral Palsy. J Child Neurol. 2014;29(8):1066-1076. doi:10.1177/0883073814533196
10. Jang D-H, Sung IY. The influence of physical therapy and anti-botulinum toxin antibody on the efficacy of botulinum toxin-A injections in children with spastic cerebral palsy. Dev Neurorehabil. 2014;17(6):414-419. doi:10.3109/17518423.2014.938834
11. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-223. doi:10.1111/j.1469-8749.1997.tb07414.x
12. Kim M-W, Kim J-H, Yang Y-J, Ko Y-J. Anatomic Localization of Motor Points in Gastrocnemius and Soleus Muscles. Am J Phys Med Rehabil. 2005;84(9):680-683. doi:10.1097/01.phm.0000176341.85398.a9
13. Intiso D. Therapeutic Use of Botulinum Toxin in Neurorehabilitation. J Toxicol. 2012;2012:1-12. doi:10.1155/2012/802893
14. Tilton AH. Injectable Neuromuscular Blockade in the Treatment of Spasticity and Movement Disorders. J Child Neurol. 2003;18(1_suppl):S50-S66. doi:10.1177/0883073803018001S0701
15. Kinnett D. Botulinum toxin A injections in children: Technique and dosing issues. Am J Phys Med Rehabil. 2004;83(10 SUPPL.):59-64. doi:10.1097/01.PHM.0000141131.66648.E9
16. Koman LA, Paterson Smith B, Balkrishnan R. Spasticity Associated with Cerebral Palsy in Children. Pediatr Drugs. 2003;5(1):11-23. doi:10.2165/00148581-200305010-00002
17. Gambart G, Mette F, Pellot AS, Richard I. Évaluation d’une procédure antalgique associant protoxyde d’azote et crème EMLA lors des injections de toxine botulique chez l’enfant. Ann Readapt Med Phys. 2007;50(5):275-279. doi:10.1016/j.annrmp.2007.02.003
18. Brochard S, Blajan V, Lempereur M, et al. Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children. Ann Phys Rehabil Med. 2009;52(10):704-716. doi:10.1016/j.rehab.2009.09.001
19. Grunau RE, Holsti L, Peters JWB. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006;11(4):268-275. doi:10.1016/j.siny.2006.02.007
20. Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci. 2005;6(7):507-520. doi:10.1038/nrn1701
21. Chen X, Xu L, Wang Y, Xu F, Du Y, Li J. Sevoflurane affects evoked electromyography monitoring in cerebral palsy. Open Med. 2016;11(1):138-142. doi:10.1515/med-2016-0027
22. van der Baan A, Kortekaas KA, van Es E, Meier S, Klautz RJM, Engbers FHM. Sevoflurane-enriched blood cardioplegia: the intramyocardial delivery of a volatile anesthetic. Perfusion. 2015;30(4):295-301. doi:10.1177/0267659114545666
23. Ruszkai Z, Bokrétás GP, Bartha PT. Sevoflurane therapy for life-threatening acute severe asthma: a case report. Can J Anesth Can d’anesthésie. 2014;61(10):943-950. doi:10.1007/s12630-014-0213-y
24. Pokkinen Sm, Yli-Hankala A, Kalliomäki M-L. The effects of propofol vs. sevoflurane on post-operative pain and need of opioid. Acta Anaesthesiol Scand. 2014;58(8):980-985. doi:10.1111/aas.12366
25. He J, Zhang Y, Xue R, Lv J, Ding X, Zhang Z. Effect of Desflurane versus Sevoflurane in Pediatric Anesthesia: A Meta-Analysis. J Pharm Pharm Sci. 2015;18(2):199. doi:10.18433/J31882
26. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: A comparison with halothane. Paediatr Anaesth. 2000;10(4):419-424. doi:10.1046/j.1460-9592.2000.00560.x
27. Tait AR, Pandit UA, Voepel-Lewis T, Munro HM, Malviya S. Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation. Anesth Analg. 1998;86(4):706-711. doi:10.1097/00000539-199804000-00006
28. Bordet F, Allaouchiche B, Lansiaux S, et al. Risk factors for airway complications during general anaesthesia in paediatric patients. Paediatr Anaesth. 2002;12(9):762-769. doi:10.1046/j.1460-9592.2002.00987.x
29. Yoon IJ, Kang H, Baek CW, et al. Comparison of effects of desflurane and sevoflurane on postoperative nausea, vomiting, and pain in patients receiving opioid-based intravenous patient-controlled analgesia after thyroidectomy. Medicine (Baltimore). 2017;96(16):e6681. doi:10.1097/MD.0000000000006681