Paediatric Anaesthesia zyxwvutsr 1995 zyxwvutsrq 5: zyxwvutsrqp 165-170 Prevalence of unsuspected myopathy in infants presenting for clubfoot surgery zyx GASTONE ZANETTE zyxwv m*, GIOVANNI MANANIt, GIOVANNI PITTONI m*, CORRADO ANGELINIS, CARLO P. TREVISAN~, SISTO TURRA~ ‘Anaestheswlogy and Intensive Care Institute, ‘General and Dental Anaesthesia Depurtment, $Neurologic Clinic and SOrthopaedic Department, University of Padua, Italy Summa y The objective of this study was an evaluation of the prevalence of myopathies in paediatric patients scheduled for orthopaedic surgery (clubfoot)performed under regional anaesthesia. Seventeen infants scheduled for lower limb orthopaedic surgery were studied to verify coexisting neuromuscular disorders with electromyography and muscle biopsy during surgery. All surgical procedures were performed under caudal block or spinal anaesthesia, associated with light general anaesthesia. No major cardiorespiratory, neurological or malignant hyperthermic complications (muscle rigidity, arrhythmias, hyperpyrexia) were observed. Combined neurological, electromyographic and biopsy studies showed a high rate of myopathic changes (70%). Performance of clubfoot surgery under light general anaesthesia with regional techniques was free from any problems. The high rate of myopathic changes (70%) observed in the muscle biopsies suggests that precautions should be taken with paediatric patients for clubfoot surgery and a regional anaesthesia technique with adequate monitoring may be helpful to prevent possible malignant hyperthermia related problems. Keywords: regional anaesthesia, myopathy, muscle biopsy, malignant hyperthermia, clubfoot surgery Introduction The aim of this study was to evaluate the pre- valence of myopathic changes in paediatric patients having clubfoot surgery under regional anaesthesia. These paediatric patients are considered at risk for development of malignant hyperthermia (MH) (Smith 1988; Mortier 1990) and regional anaesthesia, Correspondence zyxwvutsrqpon to: Gastone Zanette, Anaesthesiology and Inten- sive Care Institute, University of Padua, via Cesare Battisti, 267, 35121, Padova, Italy when practicable, may be a useful anaesthetic tech- nique (Berkowitz zyxw & Rosenberg 1985; Saint-Maurice & schulte Steinberg 1990; Breucking & Mortier 1993). General anaesthesia or deep sedation has always been used before the administration of regional anaesthesia in children (Armitage 1988; Dalens 1990; Dalens & Mansoor 1993). Therefore avoidance of triggering anaesthetics and adequate monitoring are of paramount importance in preventing MH related problems in paediatric patients presenting for club- foot surgery (Stelzner et zyxw al. 1993). In this paper we 0 1995 Amette.Blackwell Ltd 165