The ankle clonus test is not a clinically useful measure of spinal cord integrity in children

Alastair Ewen; Robin G Cox; Sîon A Davies; Jeremy B Luntley; Yair Rubin; Gordon H Fick; Bevin B Bart

doi:10.1007/BF03016533

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The ankle clonus test is not a clinically useful measure of spinal cord integrity in children

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The ankle clonus test is not a clinically useful measure of spinal cord integrity in children

Alastair Ewen, Robin G Cox, Sîon A Davies, Jeremy B Luntley, Yair Rubin, Gordon H Fick and Bevin B Bart

Canadian journal of anesthesia, Vol.52(5), pp.524-529

05/01/2005

DOI: 10.1007/BF03016533

PMID: 15872132

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Abstract

PURPOSEBilateral flexion-induced ankle clonus has been proposed as a test of spinal cord integrity during anesthesia for scoliosis surgery. The purpose of this study was to establish the reliability of this test in normal children emerging from volatile anesthesia. A secondary objective was to determine if there was a difference in the validity of this test with either sevoflurane or isoflurane anesthesia.METHODSIn a randomized, prospective blinded clinical trial, 32 healthy children aged three to 13 yr, were randomized to receive either isoflurane (Group I, n = 15) or sevoflurane (Group S, n = 17) for maintenance of anesthesia during dental restorative surgery. During emergence, an observer, blinded to group allocation, recorded ankle clonus scores (number of beats to a maximum of 5 on each side) at 60-sec intervals until tracheal extubation. End-tidal anesthetic concentration was measured contemporaneously.RESULTSNon-sustained ankle clonus was elicited in a majority of children during emergence: 13 (87%) patients in Group I and 15 (88%) in Group S demonstrated at least non-sustained or unilateral clonus. However, bilateral sustained (> 5 beats.min(-1)) ankle clonus occurred in only four (27%) patients in Group I and four (24%) patients in Group S (P = 0.83).CONCLUSIONWe conclude that the specificity of the ankle clonus test is too low to be clinically useful as a measure of spinal cord integrity in children, both when isoflurane and sevoflurane are used as the primary anesthetic agent.

Details

Title: Subtitle: The ankle clonus test is not a clinically useful measure of spinal cord integrity in children
Creators: Alastair Ewen - Alberta Children's Hospital
Robin G Cox - Alberta Children's Hospital
Sîon A Davies - Alberta Children's Hospital
Jeremy B Luntley - Alberta Children's Hospital
Yair Rubin - Alberta Children's Hospital
Gordon H Fick - Alberta Children's Hospital
Bevin B Bart - Alberta Children's Hospital
Resource Type: Journal article
Publication Details: Canadian journal of anesthesia, Vol.52(5), pp.524-529
DOI: 10.1007/BF03016533
PMID: 15872132
NLM abbreviation: Can J Anaesth
ISSN: 0832-610X
eISSN: 1496-8975
Language: English
Date published: 05/01/2005
Academic Unit: Anesthesia
Record Identifier: 9984296134502771

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