Anesthesia management of familial dysautonomia
FELICIA B. AXELROD MD
Department of Pediatrics, New York University School of Medicine, New York, NY, USA
Search for more papers by this authorFELICIA B. AXELROD MD
Department of Pediatrics, New York University School of Medicine, New York, NY, USA
Search for more papers by this authorSummary
Familial dysautonomia (FD) is an autosomal recessive inherited disorder, predominantly affecting the Ashkenazi Jewish population that is characterized by sensory and autonomic neuropathy. The protean manifestations and perturbations result in high morbidity and mortality. However, as a result of supportive measures and centralized care, survival has improved. As surgical options are increasing to symptomatically treat FD, anesthesiologists need to be familiar with this disorder. Because the Dysautonomia Center at NYU Medical Center is a referral center for FD patients, we have attained considerable anesthetic experience with FD. This article reviews clinical features of FD that could potentially affect anesthetic management and outlines our present practices.
References
- 1
Axlerod FB.
Hereditary sensory and autonomic neuropathies: familial dysautonomia and other HSANs.
Clin Auton Res
2002; 12(Suppl. 1): 2–14.
10.1007/s102860200014 Google Scholar
- 2 Pearson J, Axelrod FB, Dancis J. Current concepts of dysautonomia: neurological defects. Ann NY Acad Sci 1974; 228: 288–300.
- 3 Axelrod FB. Familial dysautonomia (Invited Review). Muscle Nerve 2004; 29: 352–363.
- 4 Axelrod FB, Schneider KM, Ament ME et al. Gastroesophageal fundoplication and gastrostomy in familial dysautonomia. Ann Surg 1982; 195: 253–258.
- 5 Axelrod FB, Gouge TH, Ginsburg HB et al. Fundoplication and gastrostomy in familial dysautonomia. J Pediatr 1991; 118: 388–394.
- 6 Kaplan L, Margulies JY, Kadari A et al. Aspects of spinal deformity in familial dysautonomia (Riley-Day syndrome). Eur Spine J 1997; 6: 33–38.
- 7 Rubery PT, Spielman JH, Hester P et al. Scoliosis in familial dysautonomia. J Bone Joint Surg 1995; 77: 1362–1369.
- 8 Laplaza J, Turajane T, Axelrod FB et al. Non-spinal orthopaedic problems in familial dysautonomia. J Pediatr Orthoped 2001; 21: 229–232.
- 9 Gold-von Simson G, Rutkowski M, Berlin D et al. Pacemakers in patients with familial dysautonomia. A review of experience with 20 patients. Clin Auto Res 2005; 15: 15–20.
- 10 Meridy HW, Creighton RE. General anesthesia in eight patients with familial dysautonomia. Canad Anaesth Soc J 1971; 18: 563–570.
- 11 Challands JF, Facer EK. Epidural anesthesia and familial dysautonomia (the Riley-Day syndrome). Three case reports. Paediatr Anaesth 1998; 8: 83–88.
- 12 Stenqvist O, Sigurdsson J. The anaesthetic management of a patient with familial dysautonomia. Anaesthesia 1982; 37: 929–932.
- 13 Kritchman MM, Schwartz H, Papper EM. Experiences with general anesthesia in patients with familial dysautonomia. JAMA 1959; 170: 529–533.
- 14 Dell'Oste C, Vincenti E, Torre G. Multiple and various anaesthetics, ketamine included, in a young patient with familial dysautonomia. Minerva Pediatrica 1996; 48: 113–116.
- 15 Wengrower D, Gozal D, Goldin E. Familial dysautonomia: deep sedation and management in endoscopic procedures. Am J Gastroenterol 2002; 97: 2550–2552.
- 16 Axelrod FB, Donnenfeld R, Danziger F et al. Anesthesia in familial dysautonomia. Anesthesiology 1988; 68: 631–635.
- 17 Riley CM, Day RL, Greeley DM et al. Central autonomic dysfunction with defective lacrimation: report of 5 cases. Pediatrics 1949; 3: 468–477.
- 18 Blumenfeld A, Slaugenhaupt SA, Axelrod FB et al. Localization of the gene for familial dysautonomia on chromosome 9 and definition of DNA markers for genetic diagnosis. Nat Genet 1993; 4: 160–164.
- 19 Slaugenhaupt SA, Blumenfeld A, Gill SP et al. Tissue-specific expression of a splicing mutation in the IKBKAP gene causes familial dysautonomia. Am J Human Genetics 2001; 68: 598–604.
- 20 Anderson SL, Coli R, Daly IW et al. Familial dysautonomia is caused by mutations of the IKAP gene. Am J Hum Genet 2001; 68: 753–758.
- 21 Leyne M, Mull J, Gill SP et al. Identification of the first non-Jewish mutation in familial dysautonomia. Am J Med Genet 2003; 118A: 305–308.
- 22 Pearson J, Pytel B. Quantitative studies of sympathetic ganglia and spinal cord intermedio-lateral gray columns in familial dysautonomia. J Neurol Sci 1978; 39: 47–59.
- 23 Grover-Johnson N, Pearson J. Deficient vascular innervation in familial dysautonomia, an explanation for vasomotor instability. Neuropath Appl Neurobiol 1976; 2: 217–224.
- 24 Smith AA, Hirsch JI, Dancis J. Responses to infused methacholine in familial dysautonomia. Pediatrics 1965; 36: 225–230.
- 25 Smith AA, Dancis J, Breinin G. Ocular responses to autonomic drugs in familial dyautonomia. Invest Ophthalmol 1965; 4: 358–361.
- 26 Smith AA, Taylor T, Wortis SB. Abnormal catecholamine metabolism in familial dysautonomia. N Engl J Med 1963; 268: 705–707.
- 27 Axelrod FB, Goldberg JD, Ye XY et al. Survival in familial dysautonomia: impact of early intervention. J Pediatr 2002; 141: 518–523.
- 28 Brunt PW, McKusick VA. Familial dysautonomia. A report of genetic and clinical studies with a review of the literature. Medicine 1970; 48: 343–374.
- 29 Axelrod FB, Zupanc M, Hilz MJ et al. Ictal SPECT during autonomic crisis in familial dysautonomia. Neurology 2000; 55: 122–125.
- 30 Sundaram V, Axelrod FB. Gastroesophageal reflux in familial dysautonomia: correlation with crisis frequency and sensory dysfunction. J Ped Gastroenterol Nutr 2005; 40: 429–433.
- 31 Axelrod FB, Nachtigall R, Dancis J. Familial Dysautonomia: diagnosis pathogenesis and management. In: I Schulman, ed. Advances in Pediatrics. Chicago: Yearbook Publishers, 1974: 75–96.
- 32 Edelman NH, Cherniack NS, Lahiri S. The effects of abnormal sympathetic nervous function upon the ventilatory response to hypoxia. J Clin Invest 1970; 41: 1153–1165.
- 33 Filler J, Smith AA, Stone S et al. Respiratory control in familial dysautonomia. J Pediatr 1965; 66: 509–516.
- 34 Bernardi L, Hilz M, Stemper B et al. Respiratory and cerebrovascular responses to hypoxia and hypercapnia in familial dysautonomia. Am J Respir Crit Care Med 2003; 167: 141–149.
- 35 Smith AA, Farbman A, Dancis J. Absence of taste bud papillae in familial dysautonomia. Science 1965; 147: 1040–1041.
- 36 Udassin R, Seror D, Vinograd I et al. Nissen fundoplication in the treatment of children with familial dysautonomia. Am J Surg 1992; 164: 332–336.
- 37 Bickel A, Axelrod FB, Marthol H et al. Sudomotor function in familial dysautonomia. J Neurol Neurosurg Psychiatry 2004; 75: 275–279.
- 38 Axelrod FB. Familial dysautonomia. In: FD Burg, JR Ingelfinger, RA Polin, eds. Current Pediatric Therapy, 15th edn. Philadelphia: WB Saunders Co, 1996: 91–94.
- 39 Smith AA, Dancis J. Catecholamine release in familial dysautonomia. N Engl J Med 1967; 277: 61–64.
- 40 Ziegler MG, Lake R, Kopin IJ. Deficient sympathetic nervous response in familial dysautonomia. N Engl J Med 1976; 294: 630–633.
- 41 Axelrod FB, Glickstein JS, Weider J et al. The effects of postural change and exercise on renal haemodynamics in familial dysautonomia. Clin Auton Res 1993; 3: 195–200.
- 42 Axelrod FB, Krey L, Glickstein JS et al. Atrial natriuretic peptide and catecholamine response to orthostatic hypotension and treatments in familial dysautonomia. Clin Auton Res 1994; 4: 311–318.
- 43 Glickstein JS, Schwartzman D, Friedman D et al. Abnormalities of the corrected QT interval in familial dysautonomia: an indicator of autonomic dysfunction. J Pediatr 1993; 122: 925–928.
- 44 Pearson J, Gallo G, Gluck M et al. Renal disease in familial dysautonomia. Kidney Int 1980; 17: 102–112.
- 45 Winkelmann RK, Bourland A, Smith AA. Nerves in the skin of a patient with familial dysautonomia (Riley-Day syndrome). Pediatrics 1966; 38: 1060–1062.
- 46 Axelrod FB, Iyer K, Fish I. Progressive sensory loss in familial dysautonomia. Pediatrics 1981; 65: 517–522.
- 47 Tirosh I, Hoffer V, Finkelstein Y et al. Heat stroke in familial dysautonomia. Pediatr Neurol 2003; 29: 164–166.
- 48 Axelrod FB. Familial dysautonomia: a review of the current pharmacological treatments. Expert opinion on pharmacotherapy. Ashley Publications 2005; 6: 561–567.
- 49 Marthol H, Tutaj M, Brys M et al. Clonidine improves postprandial baroreflex control in familial dysautonomia. Eur J Clin Invest 2003; 33: 912–918.
- 50 Nishina K, Mikawa K, Shiga M et al. Clonidine in paediatric anaesthesia. Paediatr Anaesth 1999; 9: 187–202.
- 51 Eisenach J, Detweiler D, Hood D. Hemodynamic and analgesic effects of epidurally administered clonidine. Anesthesiology 1993; 78: 277–287.
- 52 Ambrose C, Sale S, Howells R et al. Intravenous clonidine infusion in critically ill children: dose-dependent sedative effects and cardiovascular stability. Br J Anaesth 2000; 84: 794–796.
- 53 Axelrod FB, Maayan C. Familial dysautonomia. In: V Chernick, TF Boat, eds. Kendig's Disorders of the Respiratory Tract in Children, 6th edn. Canada: WB Saunders, 1998: 1103–1106.
- 54 Chaikin AA, Giarraffa P, Berger KI et al. High frequency chest wall oscillation improves pulmonary health outcomes and function in patients with familial dysautonomia. Chest 2003; 92S, October meeting.