entwistle_2006_scoliosis_surgery_in_children.pdf
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- Full Title: entwistle_2006_scoliosis_surgery_in_children.pdf
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- s is a lateral curvature and rotation of aco-lumbar vertebrae with a resulting deformity. It may be id to neuromuscular disease, infection, or injury (Table 1). ature is measured pat the Su (Page 1)
- heart failure (>100(cid:1)). Surgery is d once the curvature is >40(cid:1). strictive lung defect attributable to (Page 1)
- MAC in air and oxygen, with an infusion of tanil. A bolus of i.v. morphine is given towards the end ery. Succinylcholine is contraind (Page 2)
- ire echoraphy. Spirometry is performed routinely on all patients l usually show a restrictive lg defect. There is evidence liosis surgery can be well tolerated despite severe restrictive ease (FVC < 32%).3 Approximately 25% patients abd epi me (Page 2)
- ry. The head be positioned carefully and secured to prevent excessive extension or rotation of t (Page 2)
- opathic scoliosis ative assessment of patients with neuromuscular disease or lity is more difficult. They are neither able to give a history ise tolerance nor perform spirometry adequately. Muscurophies may be complicated by subclinical cardiomyMore than 50% of patients with Duchenmuscular hy have some degree of dilated cardiomyopathy and ion fraction <45% by 15 yr of age.4 Any reduction in fraction may mean difficulties coping with the rapid fts during surgery. Echocardiography is requir ner tect sho Vul be Mo Sco los to (Page 2)
- sis. Factors ing the degree of blood loss include the number of levels uration of surgery and hypothermia. Children with neurlar disease are at increased risk of excessive blood loss.6 ve mor (Page 3)
- gulation estimations. zing blood loss re to allogenic blood transfusions can be reduced by techo minimize blood loss.7 Simple measures include careful ing to avoid inferior vena cava compression, preventing rmia, correction of coagulopathy and good su blo stas blo this (Page 3)
- pression stockings and pneumatic boots are used as oprophylaxis, avoiding anticoagulants. rolled hypotension has been shown to reduce blood loss spinal surgery. Many methods have been described; r, a mean arterial pressure of 50–60 mm Hg can be with a remifentanil infusion and volatile agent the need for vasodilators. Hypotension and surgical lation may reduce spinal cord perfusion and so risk gical is therefore impor injury. It blo has De trai of (Page 3)
- logical monitoring gical injury may occur because of direct spinal cord e damage during instrumentation, distraction injury or spinal cord perfusion resulting in ischaemia. Intra (Page 3)
- ous intraoperative neurophysiological monitoring vous system is stimulated and the response is monitored the area of spina sory evoked potentials (SSEPs) or motor evoked ls (MEPs). monitoring involves stimulating a peripheral nerve, e posterior tibial nerve, and then detecting a response dural or scalp electrodes. The evoked potentials are averre than 2–3 min to eliminate background noise then diss voltage against time. Nerve injury may be indicated by (Page 3)
- g signal is detected with epidural electrodes or as nd muscle action potentials (CMAPs). sthetic technique impacts upon spinal cord monitoring. agents, propofol and nitrous oxide all depress SSEPs Ps; however, opioids have little effect. Neuromuscular g agents may reduce background noise when using but a profound block will prevent CMAPs. Decreases d pressure and temperature may also depress signals. recordings are made after induction of anaesthesia eady state maintained to minimize drug induced changes. reased amplitude, increased latency or loss of waveform en be attributed to neurological injur inf sur nee via -b of infl red ope NS (Page 4)
- erative ‘wake-up’ test ke-up’ test provides a snapshot of spinal cord motor . Surgery is halted, the volatile agent switched off and ce allowed. The patient is asked to move their feet and, is occurs, anaesthesia can be recommenced. Assistance is to prevent patient movement which may cause accidental ion or loss of vascular cannulae. In the event of new gia, all imp (Page 4)