Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis

BACKGROUND

Neuromuscular scoliosis (NMS) is associated with progressive restrictive lung disease and an increased risk of prolonged ventilation following surgery. This study reports the experiences of a single institution and evaluates whether preoperative pulmonary function tests (PFT) can predict the development of postoperative pulmonary complications.

METHODS

Correlations between preoperative PFT (forced expired volume in 1 s, FEV(1); forced vital capacity, FVC) findings and postoperative pulmonary complications were searched for among 74 NMS patients who underwent surgical correction at our medical center from 2002 to 2008.

RESULTS

Thirty-seven patients (50%) developed a pulmonary complication. The independent factors found to contribute to the development of a pulmonary complication were: FEV(1) <40% of the predicted value (P = 0.007), FVC <39.5% of the predicted value (P = 0.005), a larger Cobb angle (>69°) (P = 0.002), and older age (>16.5 years) (P = 0.027). Of these 37 patients, 6 needed postoperative ventilation. PFT findings found to be independently associated with the need for postoperative ventilation were: FEV(1) <40% of the predicted value (P = 0.017) and FVC <39.5% of the predicted value (P = 0.015).

CONCLUSIONS

NMS patients with a preoperative FVC of <39.5% of the predicted value, an FEV(1) <40% of the predicted value, a Cobb angle of >69°, or age >16.5 years were found to be more likely to develop a postoperative pulmonary complication.

Successful removal of indigested shell using a rigid esophagoscope and a pneumatic lithotriptor

Foreign body ingestion is a commonly encountered clinical problem in pediatric emergency cases. The authors report a case of an esophageal foreign body caused by the accidental ingestion of a shell in an 8-month-old girl. Endoscopic removal was attempted but failed because of the sharp margin of the shell and caused it to be deeply impacted into the esophageal wall. Accordingly, a pneumatic lithotriptor was inserted through a rigid esophagoscope and used to fragment the shell.