Children with infantile neuronal ceroid lipofuscinosis have an increased risk of hypothermia and bradycardia during anesthesia.

Abstract

BACKGROUND:

Neuronal ceroid lipofuscinoses (NCLs) are a group of autosomal recessive neurodegenerative diseases characterized by lysosomal accumulation of autofluorescent material in neurons and other cell types. The infantile NCL (INCL) subtype is rare (1 in >100,000 births), the most devastating of childhood subtypes, and is caused by mutations in the gene CLN1, which encodes palmitoyl-protein thioesterase-1.

METHODS:

To investigate the incidence of hypothermia and bradycardia during general anesthesia in patients with INCL, we conducted a case-control study to examine the perianesthetic course of patients with INCL and of controls receiving anesthesia for diagnostic studies.

RESULTS:

Eight children with INCL (mean age 25 mo [range, 10-32] at first anesthetic) and 25 controls (mean age 44 mo [range, 18-92]) underwent 62 anesthetics for nonsurgical procedures. Patients with INCL had neurologic deficits including developmental delay, myoclonus, and visual impairment. Patients with INCL had lower baseline temperature (36.4 +/- 0.1 vs 36.8 +/- 0.1, INCL versus controls, P < 0.007), and during anesthesia, despite active warming techniques, had significantly more hypothermia (18 vs 0 episodes, P < 0.001) and sinus bradycardia (10 vs 1, P < 0.001) compared with controls. INCL diagnosis was significantly associated with temperature decreases during anesthesia (P < 0.001), whereas age, sex, and duration of anesthesia were not (P = NS).

CONCLUSIONS:

We report that patients with INCL have lower baseline body temperature and during general anesthesia, despite rewarming interventions, are at increased risk for hypothermia and bradycardia. This suggests a previously unknown INCL phenotype, impaired thermoregulation. Therefore, when anesthetizing these children, careful monitoring and routine use of warming interventions are warranted.

• Authors: Ning Miao, Sondra W Levin, Eva H Baker, Rafael C Caruso, Zhongjian Zhang, Andrea Gropman, Deloris Koziol, Robert Wesley, Anil B Mukherjee, Zenaide M N Quezado
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 109 Issue 2 Pg. 372-8 (Aug 2009) ISSN: 1526-7598 [Electronic] United States
• PMID: 19608805 (Publication Type: Journal Article, Research Support, N.I.H., Intramural)

Chemical References

• Anesthetics

Topics

• Anesthesia (adverse effects)
• Anesthetics
• Body Temperature (drug effects)
• Bradycardia (epidemiology, etiology)
• Case-Control Studies
• Child, Preschool
• Female
• Humans
• Hypothermia (epidemiology, etiology)
• Infant
• Intraoperative Complications (epidemiology)
• Male
• Monitoring, Intraoperative
• Neuronal Ceroid-Lipofuscinoses (complications, physiopathology)
• Rewarming
• Risk Assessment