Bilateral common peroneal nerve injury after pediatric cardiothoracic surgery: A case report and review of the literature.

Nerve injuries after thoracic and cardiovascular surgery have been reported but generally concern the brachial plexus, phrenic nerve, recurrent laryngeal, and facial nerve. Common peroneal nerve injury (CPNI) following cardiopulmonary bypass has been reported in adults (4); however bilateral injury is extremely uncommon. Age, low body weight, co-morbidities such as peripheral arteriosclerotic disease, diabetes mellitus, and arrhythmias were associated with CPNI following cardiothoracic surgery in adults. Common peroneal nerve injury (CPNI) following cardiopulmonary by-pass has been reported in adults; however, bilateral injury is extremely uncommon. The superficial course of CPN makes it vulnerable to traction or compression. We report a 5-year-old girl manifesting with bilateral CPNI following prolonged cardiopulmonary by-pass. To the best of our knowledge, she is the first pediatric patient presenting with bilateral CPNI following cardiothoracic surgery and cardiopulmonary by-pass.

Responses to nondepolarizing neuromuscular blockers and succinylcholine in von Recklinghausen neurofibromatosis.

Patients with type 1 neurofibromatosis (NF-1) have been reported to have prolonged responses to nondepolarizing (ND) neuromuscular blockers (NMBs). Responses to succinylcholine (SCh) have been described as increased, decreased, or normal. The purpose of this study was to assess responses to NMBs in NF-1 patients in order to determine the clinical significance of abnormal responses. We retrospectively identified all NF-1 patients who received anesthetics at Strong Memorial Hospital between January 1, 1984 and December 31, 1994. We then reviewed all anesthetic records to classify responses to NMBs as normal, abnormal, or indeterminate. Records of 114 anesthetics provided to 44 NF-1 patients were reviewed. Nondepolarizing NMBs were used during 73 anesthetic cases in 38 patients. Responses were normal in 69 cases and indeterminate in 4 (3 in patients with normal responses during other anesthetics). SCh was used during 42 anesthetic cases in 23 patients. Responses were normal in all but one case (indeterminate) in a patient who had had other documented normal responses. Standard milligram per kilogram doses of NMBs were used in all cases, and in none was there evidence of abnormal response. The risk of abnormal response to NMBs in individuals with NF-1 appears to be minimal. We recommend no alteration in dosing of either SCh or ND NMBs in patients with NF-1.