Anesthetic Management of Scoliosis Surgery in Children

Mapping Intimacies ◽

10.1093/med/9780190685157.003.0029 ◽

2018 ◽

Author(s):

Arati Patil ◽

Sophie R. Pestieau

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Blood Loss ◽

Spinal Fusion ◽

Surgical Repair ◽

Perioperative Complications ◽

Anesthetic Management ◽

Congenital Scoliosis ◽

Posterior Spinal Fusion ◽

Scoliosis Surgery

Scoliosis is defined as an abnormal curvature of the spine, which, if severe enough, can affect pulmonary or cardiac function and ultimately require surgical repair. There are 3 well-defined types of scoliosis: idiopathic, neuromuscular, and congenital scoliosis. Anesthetic management of children undergoing posterior spinal fusion can be challenging due to patient comorbidities, the need for neuromonitoring, the potential for significant blood loss, and various perioperative complications. In addition, postoperative pain after spinal fusion is known to be severe and often exceeds those reported in other major surgical procedures. To properly care for these patients, it is vital to be knowledgeable about the anesthetic and pain management considerations of patients undergoing posterior spinal fusion.

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Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

Scoliosis and Spinal Disorders ◽

10.1186/s13013-018-0165-z ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Hiroyuki Seki ◽

Satoshi Ideno ◽

Taiga Ishihara ◽

Kota Watanabe ◽

Morio Matsumoto ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Postoperative Pain Management ◽

Posterior Spinal Fusion ◽

Narrative Review

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Cyanotic Congenital Cardiac Disease and Scoliosis: Pre-Operative Assessment, Surgical Treatment, and Outcomes

Medical Principles and Practice ◽

10.1159/000501840 ◽

2019 ◽

Vol 29 (1) ◽

pp. 46-53

Author(s):

Athanasios I. Tsirikos ◽

George A. Augustithis ◽

Greg McKean ◽

Christos Karampalis

Keyword(s):

Left Ventricle ◽

Blood Loss ◽

Spinal Fusion ◽

Cardiac Disease ◽

Posterior Spinal Fusion ◽

Fontan Circulation ◽

Scoliosis Surgery ◽

Surgical Time ◽

Hypotensive Anaesthesia ◽

Double Inlet Left Ventricle

Objective: Congenital heart disease (CHD) is associated with the development of scoliosis. Improvements in cardiac care have extended survival of children with cyanotic CHD which possess a need for correction of scoliosis. There is limited information on spinal care for these patients. We present 3 patients with CHD who underwent surgical correction of scoliosis. Materials and Methods: We reviewed demographic and clinical data on patients with cyanotic CHD. Results: Patient 1 underwent posterior spinal fusion T3–L3 at the age of 16 years. He had a double inlet left ventricle and was treated with completion of a Fontan circulation. Hypotensive anaesthesia was used but he lost 3,000 mL of blood. The operative time was 370 min and most of the blood loss occurred in the second half of the procedure. Patient 2 underwent posterior spinal fusion T5–T12 when aged 14 years. She had transposition of the great vessels corrected over multiple surgeries. Hypotensive anaesthesia was used, she had blood loss of 300 mL, and the surgical time was 282 min. Patient 3 underwent posterior spinal fusion extending from T5–T12 when he was 17 years old. He had a double inlet left ventricle and was treated with completion of a Fontan circulation. Hypotensive anaesthesia was used, he had blood loss of 1,021 mL, and a surgical time of 342 min. Conclusion: Scoliosis surgery in patients with complex cardiac disease may be indicated to treat progressive deformities which produce severe symptoms. A multidisciplinary approach including a spinal surgeon as well as a cardiologist, haematologist, respiratory paediatrician, and spinal anaesthetist can evaluate the general medical condition and weigh the benefits and risks of surgery. Deformity correction can be performed using a meticulous technique and has produced a series of satisfactory outcomes.

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Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03869-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yulei Dong ◽

Ning Tang ◽

Shengru Wang ◽

Jianguo Zhang ◽

Hong Zhao

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Subgroup Analysis ◽

Congenital Scoliosis ◽

Scoliosis Surgery ◽

Intraoperative Blood Loss ◽

Ponte Osteotomy

Abstract Background To assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery. Methods Data of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients’ demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed. Results In this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT. Conclusions Method of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT. Level of evidence Level III.

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Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04104-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chris Yuk Kwan Tang ◽

Vijay H. D. Kamath ◽

Prudence Wing Hang Cheung ◽

Jason Pui Yin Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Predictive Factors ◽

Posterior Spinal Fusion ◽

Male Gender ◽

Intraoperative Blood Loss ◽

Operative Blood Loss ◽

Operation Duration

Abstract Background Adolescent idiopathic scoliosis (AIS) is a common spinal deformity. Posterior spinal fusion remains an important surgical treatment for AIS. This study aims to determine the predictive factors for intraoperative blood loss in AIS surgery. Methods Patients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis in a single university hospital were reviewed over a 7-year period. Predictive factors for intra-operative blood loss were studied by multivariate analysis to derive a regression model. Receiver operating characteristic analysis was performed to determine the cut-off values of factors contributing to significant intraoperative blood loss (≥500 ml). Results Two hundred and twelve patients were included. Intraoperative blood loss was found to be correlated with gender (rs = 0.30 (0.17–0.43)), preoperative hemoglobin level (rs = 0.20 (0.04–0.31)), preoperative Cobb angle (rs = 0.20 (0.02–0.29)), number of fused levels (rs = 0.46 (0.34–0.58)), operation duration (rs = 0.65 (0.54–0.75)), number of anchors (rs = 0.47 (0.35–0.59)), and p-value ranged from < 0.001 to < 0.05. Significant intraoperative blood loss was influenced by the male gender, operation duration greater than 257.5 min and more than 10 anchors used. Conclusions Male gender, increased operation duration and higher number of anchors predicted higher intra-operative blood loss.

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