NOTE: This Message was originally addressed to Tom Mckeever
      from Dempt@eskimo.com and was forwarded to you by Tom Mckeever
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> Anesthesia: Considerations for Polio Survivors
>
>     
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>
> POLIO NETWORK NEWS: Dr. Spencer, we have received several requests for
> information concerning "the danger of administering certain
> anaesthetics to polio survivors." Please clarify the issues.
>
> GEOFFREY T. SPENCER, OBE, MB, BS, FFARCS, CONSULTANT, DEPARTMENT OF
> ANAESTHETICS, LANE FOX RESPIRATORY UNIT, ST. THOMAS' HOSPITAL, LONDON,
> ENGLAND:
>
> The problem is not straightforward, but our experience is described in
> "Perioperative care in restrictive respiratory disease", J.A. Patrick,
> M. Meyer-Witting, F. Reynolds and G.T. Spencer, "Anaesthesia, 1990,
> Volume 45, pages 390-395. The article suggests that with suitable
> modification to take account of the disability, general anesthesia is
> no more dangerous for people who had polio than it is for anybody
> else, and our views are summarized in the conclusions.
>
> There is a fundamental difference between British anaesthetic practice
> and that of the States. We do not have nurse anaesthetists; all
> anaesthetics are administered by doctors. We believe that
> administration of anaesthetics by nurses substantially alters clinical
> practice in that techniques have to be standardized and routines
> established. This tends to make it more difficult to go back to basic
> considerations and modify techniques to meet particular needs.
>
> Special considerations for polio survivors can be grouped roughly into
> three categories: those resulting from the general effects of polio,
> those resulting from respiratory insufficiency as a result of polio,
> and those resulting from the surgery to be undertaken.
>
> SPECIAL CONSIDERATION FOR POLIO SURVIVORS RESULTING FROM THE GENERAL
> EFFECTS OF POLIO
>
> Patients with significant paralysis from polio have a greatly reduced
> muscle mass. Muscle normally contains a great deal of blood and
> requires a substantial blood supply to function. If much of that mass
> is lost, the total blood volume is greatly reduced, and such patients
> react to haemorrhage as does a small child. This necessitates precise
> and complete replacement of blood lost during surgery. Most patients
> with polio replace lost muscle with fat. Very few remain as thin as
> they were immediately after the acute illness. Fat contains a smaller
> proportion of water than does muscle, so the effects of water loss are
> more quickly apparent and electrolyte disturbances, particularly
> potassium loss, require careful and precise balance and replacement.
>
> SPECIAL CONSIDERATION FOR POLIO SURVIVORS RESULTING FROM THE
> RESPIRATORY EFFECTS OF POLIO
>
> Most general anaesthetics depress breathing. Mechanical respiratory
> assistance, during and after anaesthesia, in polio patients whose
> breathing is even mildly aaffected by polio is essential. It often
> needs to be maintained for longer, postoperatively, than would be
> necessary in a non-polio patient undergoing a similar operation. Most
> postoperative painkillers also depress breathing and need to be used
> with caution. Surprisingly, lperhaps, this is not as much of a
> disadvantage as it sounds. A great deal of postoperative pain is due
> to muscle damage caused by surgery. If muscles are absent or weak,
> pain is proportionately less severe, and the need for painkillers is
> thereby reduced.
>
> SPECIAL CONSIDERATION FOR POLIO SURVIVORS RESULTING FROM THE EFFECTS
> OF SURGERY
>
> Many surgical operations require the passage of an endotracheal tube,
> either for surgical access or to allow artificial ventilation to be
> performed. Removing the endotracheal tube at the end of the operation
> and re- establishing adequate spontaneous ventilation is often a
> problem. It is in this situation that the use of an iron lung can be
> of particular value for at least a short time until the patient is
> able to return to his normal methods of respiratory assistance.
>
> The use of particular anaesthetic agents is less significant than the
> overall anaesthetic techniique employed. dIn general, however, it is
> desirable and usually possible to avoid the use of muscle relaxant
> drugs. The polio muscle weakness usually renders them unnecessary, and
> it is usually impossible to reverse the action of these drugs
> completely and immediately. Residual effects tend to persist for some
> hours, and this can be a disadvantage for patients who need to use as
> much muscle strength as they possess in order to keep breathing
> adequately.
>
>     
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>
>
> ~reprinted with permission from Polio Network News, Fall 1991, Vol. 7,
> No. 4~
>
> International Polio Network
> 5100 Oakland Ave. #206
> St. Louis, MO 63110 USA
>
>     
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>
>
> POLIOEPIC - January 1992
>
 * WCE 2.01á4/2037 * "Dammit Jim, I'm a doctor, not a tagline writer."
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