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Preventing Complications in Polio Survivors Undergoing Surgery
(or) Receiving Anesthesia
Post-Polio Sequelae Monograph Series. Volume 15 (1). NY: random harvest, 2015.
Dr. Richard L. Bruno
Chairperson, International Post-Polio Task Force
and Director, International Centre for Polio Education
www.postpolioinfo.com
Unfortunately, only a handful of specialists treat Post-Polio Sequelae (PPS) - the unexpected and
often disabling fatigue, muscle weakness, joint pain, cold intolerance, swallowing, sleep and breathing
problems - occurring in America's 1.63 million polio survivors (40 years after their acute polio).1,2
However, all medical professionals need to be familiar with the neurological damage done by the original
poliovirus infection that today causes unnecessary discomfort, excessive physical pain and occasionally
serious complications after surgery. This is a brief overview to inform patients and professionals about
the cause and prevention of complications in polio survivors undergoing surgery.
PRE-OPERATIVE PREPARATION
The pre-operative period is the most important, since it is when polio survivors must establish
communication with the surgical team. After the second opinion and a polio survivor's decision to have
surgery, the patient needs to ask the surgeon to read this article and the references cited. Then, surgical
candidates must meet with the surgeon and anesthesiologist to discuss in detail patients' complete polio
and general medical histories and the problems that will likely arise before and during surgery, in the
recovery room and on the nursing floor. It is also recommended that the polio survivor meet with the
Supervisor of Nursing on the floor where they will be transferred after surgery to discuss likely problems
during the post-op and recovery period.
Lungs. We recommend that all polio survivors have pulmonary function studies as part of their pre-
operative. This is vital for those who had bulbar polio acutely, whether or not they used a respirator or
an iron lung. But, polio survivors who have (or had) neck, arm or chest muscle weakness or have
swallowing problems should also have their lung function tested 3 so there will be no unpleasant
surprises coming off the respirator at the end of the operation. Polio survivors with a lung capacity below
70% may need a respirator or respiratory therapy after surgery. 1 Of course, polio survivors who use a
respirator during the day or at night must discuss their respirator use and maintenance in detail with
their surgeon, anesthesiologist, the nursing staff, and with their own pulmonologist, before admission to
the hospital.
Physical Assistance. X-rays are a normal part of pre-op testing. Because of workers compensation
concerns, many hospital staff are not eager to move or lift patients. Unfortunately, X-ray and examining
tables are built at heights that are convenient for the professional, not the patient. Many polio survivors
cannot step on a stool to get onto a high table, or even pull themselves over onto a table from a stretcher.
Thus, polio survivors must ask for help in transferring. Since most polio survivors have no experience
asking for help under any circumstances, they need to find a phrase with which they are comfortable that
will communicate whatever their needs are. Long explanations about having had polio or PPS or the
specifics of which muscles are weak or paralyzed are not necessary. (For example, a simple "My legs
(arms) are paralyzed and I can't get onto that table” or “I will need help" should suffice). This phrase may
have to be repeated before the polio survivor will be assisted. If the professional replies, "Oh, I bet you
can move by yourself if you try!" or "Don't expect me to lift you," an appropriate response is "I cannot get