Postpolio Syndrome and Anesthesia

The development of polio vaccines 50 yr ago essentially halted childhood polio epidemics in the industrialized world. During the past quarter century, a constellation of delayed neuromuscular symptoms, called postpolio syndrome, became recognized among the aging polio survivors. The prevalence of postpolio syndrome in the U.S. population is estimated to be in the hundreds of thousands. The most common symptoms are fatigue, pain, and new onset weakness thought to be related to delayed deterioration of motor neuron function. When a patient with postpolio syndrome presents for surgery, special precautions are warranted, because these patients may have respiratory impairment, sleep apnea, swallowing difficulties, and cold intolerance. This article first reviews clinical features and some pathoetiologic theories of postpolio syndrome and then focuses on anesthetic considerations including the use of common anesthetics, neuromuscular blockade, regional anesthesia, and general anesthetic management strategies. POLIO survivors of the past century’s epidemics are now entering their fifth to seventh decades of life. Some survivors have developed a constellation of signs and symptoms referred to as postpolio syndrome (PPS). With advancing age, patients with PPS are now presenting for surgical procedures, both elective and urgent. Anesthesiologists will be better prepared to provide safe care for these patients if equipped with a solid understanding of PPS. The following review summarizes the history of polio and PPS and suggests special anesthetic considerations when approaching patients with PPS. Patients with PPS may display altered respiratory function, chronic pain syndromes, cold intolerance, risk of aspiration, and altered sensitivity to anesthetic agents (induction agents, inhaled anesthetics, neuromuscular agents, and opioids).