- Paediatric scoliosis
- Surgery is indicated once the Cobb angle is > 40 degrees
- Causes
- Idiopathic (70%)
- Early onset (infantile)
- Late onset (juvenile/adolescent)
- Neuromuscular (15%)
- Cerebral palsy
- Myopathies
- Poliomyelitis
- Friedreich's ataxia
- Congenital
- Rib abnormalities
- Vertebral abnormalities
- Traumatic
- Vertebral fractures
- Radiation
- Surgery
- Syndromes
- Marfan's
- RhA
- Osteogenesis imperfecta
- Neurofibromatosis
- Neoplastic
- Primary tumours
- Secondary tumours
- Infection
- Tuberculosis
- Osteomyelitis
- Consequences
- Cosmetic deformity
- Pain
- Restrictive lung defect
- Respiratory failure
- Cor pulmonale, PAH, R heart failure
- Anaesthetic technique
- Surgical management may be via an anterior, posterior or combined approach
- Pre-op Ix
- CXR, PFTs
- FBC, U&E, CS, G&S, calcium, phosphate
- ABGs
- ECG/echo
- Focus cardio-respiratory examination and symptoms in pre-op assessment
- Non-idiopathic causes may be associated with severe comorbidity
- May need invasive monitoring
- Catheter
- Arterial line
- 2x large bore cannulae
- ODM used commonly
- Temperature control
- ETT armoured
- Remifentanil infusion
- Positioning
- Prone for long periods of time
- Blood conservation
- Cell saver, pre-donation, acute normovolaemic haemodilution
- Higher risk in children with muscular disease
- Avoid anticoagulants
- Controlled hypotension (using neurological monitoring)
- ? Aprotinin
- Neurological monitoring
- Continuous intra-op monitoring
- SSEPs
- MEP
- Volatiles, propofol and nitrous all depress SSEPs and MEPs
- Low BP and temperature may depress signals
- If any concerns, a wake up test should be performed
- Wake up test
- May need assistance to prevent extubation
- In new paraplegia, all implants are removed, hypotension and anaemia are corrected and high dose methylprednisolone commenced
- Post-op
- Pain control
- Multimodal analgesia
- Allows physio
- Epidural or paravertebral catheter used
- May need supplementation with opioids
- NSAIDs after 24 hrs
- Monitor respiratory function
- Fluid management
- CEACCP
Link:ceaccp.oxfordjournals.org/content/6/1/13.full.pdf?sid=b799b091-c13e-4730-a11c-659555dedeab