Review of the anaesthetic management of patients with post-polio syndrome

Abstract

Post-polio syndrome (PPS) is a condition affecting individuals who have previously contracted and recovered from poliomyelitis. It is estimated that up to 20 million people worldwide are still living with the sequelae of polio, and 20–85% of these people may develop PPS. PPS, a diagnosis of exclusion, includes symptoms of new-onset muscle weakness, fatigue, pain, and muscular atrophy that occurs at least 15 yr after an acute polio infection. These patients may present for surgery with or without a formal diagnosis of PPS, requiring anaesthesia clinicians to understand the specific considerations for patients with, or at risk of, PPS. This review addresses specific anaesthetic concerns in PPS care, assessing current research to guide management and highlighting significant evidence gaps. The topics reviewed include the pathophysiology and characteristics of PPS with potential anaesthetic implications, and relevant outcomes data for patients with PPS undergoing anaesthesia. Key areas of concern in the PPS literature included respiratory function, dysphagia, cold intolerance, and sensitivity to anaesthetic agents. Existing studies on patients with PPS receiving anaesthesia were primarily case reports, with a lack of large-scale, controlled studies. Areas of continued controversy include ambiguity regarding tolerance to opioids, the use of neuraxial anaesthesia, and sensitivity to anaesthetic agents and neuromuscular blocking agents. Preoperative evaluation should include careful assessment of respiratory and swallowing function, with advanced planning for intraoperative and postoperative management using a multidisciplinary approach. Further research is needed to understand anaesthetic risks and develop evidence-based guidelines for this unique patient population.