Scoliosis surgery anesthetic treatment

BACKGROUND: This retrospective cohort study was designed to assess the impact of intrathecal morphine compared with no intrathecal morphine on blood loss and on hemodynamic stability during surgery for pediatric idiopathic scoliosis correction. METHODS: A retrospective review was done of 256 anesthetic charts who underwent scoliosis surgery between January 1993 and February 2012 by the same orthopedic surgeon. 128 patients were operated on before 2003 without intrathecal morphine (NITM group) and 128 were treated later on with intrathecal morphine (ITM group)...

BACKGROUND: Methadone is frequently administered to adults experiencing anesthesia and receiving pain treatment. Methadone pharmacokinetics in adults are well characterized, including the perioperative period. Methadone is also used in children. There is, however, no information on methadone pharmacokinetics in children of any age. The purpose of this investigation was to determine the pharmacokinetics of intravenous methadone in children undergoing surgery. Perioperative opioid-sparing effects were also assessed...

BACKGROUND: Poor surface anatomic landmarks are highly predictive of technical difficulty in neuraxial blockade. The authors examined the use of ultrasound imaging to reduce this difficulty. METHODS: The authors recruited 120 orthopedic patients with one of the following: body mass index more than 35 kg/m² and poorly palpable spinous processes; moderate to severe lumbar scoliosis; or previous lumbar spine surgery. Patients were randomized to receive spinal anesthetic by the conventional surface landmark-guided technique (group LM) or by an ultrasound-guided technique (group US)...

A 12-year-old girl with severe scoliosis underwent an operative procedure for correction of her spine deformity. Spinal cord injury is one of the most feared complications of scoliosis surgery. Therefore, it is necessary to detect spinal injury as early as possible. Intraoperative wake-up test is used to monitor spinal cord function during surgery. We used an intraoperative wake-up test with the concept of target-controlled infusion and total intravenous anesthesia (propofol and remifentanil). The use of Bispectral Index monitoring as a measure of depth of anesthesia enabled the patient to awake rapidly and consequently we did an immediate evaluation of muscle strength of lower extremities...

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To determine the effectiveness of epidural analgesia in scoliosis patients with an opened (violated) spinal canal. BACKGROUND: Postoperative continuous epidural analgesia using local anesthetics and/or opioids has been described with good success after posterior scoliosis correction. One of the concerns with the use of epidural catheters for pain control is the reliability and distribution of analgesic medication when the epidural space is violated intraoperatively by Smith-Petersen osteotomies or placement of multiple sublaminar wires...

Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. This case report describes a safe, effective technique for placing a thoracic EP catheter in a young patient undergoing anterior spine fusion surgery by thoracotomy. The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter...

The effect on pulmonary function of serial VEPTR expansion thoracoplasty was studied longitudinally in anesthetized children with spondylothoracic dysplasia using a special mobile unit. The median age of 24 children at the start of surgery was 4.6 years (1.8-10.8) and most exhibited a moderate-to-severe restrictive lung defect. After a median of 3.2 years (1.0-6.5), their forced vital capacity (FVC) was found to have increased by an average of 11.1%/year. The rate of increase was greater in children who were younger than 6 years at the start of the study than in older children (14...

BACKGROUND: In degenerative lumbar spinal disease with nerve root compression, the L5 and S1 nerve roots are the most often affected and the L3 nerve root is involved infrequently. The purpose of this study was to investigate the characteristics of L3 nerve root radiculopathy. METHODS: Seventeen consecutive patients with L3 radiculopathy were treated. The symptomatic nerve roots were determined by the pain distribution, the neurologic findings, and selective nerve root injection...

STUDY DESIGN: A retrospective review. OBJECTIVE: To review the effectiveness of blood conservation techniques in the spinal fusion of patients that refuse blood transfusion; specifically the Jehovah's witnesses population. SUMMARY OF BACKGROUND: Spinal surgery can be challenging in patients refusing blood transfusion. There is paucity in the literature examining blood conservation techniques in spinal surgery. METHODS: The radiographic and medical records of 19 Jehovah's witnesses patients who underwent spinal deformity surgery at a single institution between 2000 and 2003 were reviewed...

In this chapter, we review current techniques employed to decrease blood loss and describe the effective use of a unique bipolar electrocautery device in a patient with neuromuscular scoliosis undergoing posterior spinal fusion (PSF). The reduction of blood loss and subsequent elimination of allogeneic blood transfusion is a desired outcome in all surgeries and is a major concern during PSF. In the child or adolescent with neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the inability of the musculature to compress blood vessels, extensive surgical exposure, and the duration of the operation...

PURPOSE: Due to cardiovascular and skeletal abnormalities, anesthetic management of parturients with Marfan's syndrome can be particularly challenging. Parturients with aortic root dilatation are at risk for aortic dissection. We describe the anesthetic management of a parturient with Marfan's syndrome and aortic root dilatation, who required general anesthesia for Cesarean delivery. CLINICAL FEATURES: At 26 weeks gestation, a nulliparous woman with Marfan's syndrome presented to the Anesthesia Clinic...

Acute parotid gland enlargement in association with general anesthesia is rare and has also been called anesthesia mumps. We present two patients who were scheduled for lumbar spine surgery under general anesthesia. Each developed acute unilateral parotid gland enlargement over one side of the face proven by sonography. Case 1: A 52-year-old man was scheduled for his third lumbar spine to first sacral spine surgery for scoliosis and spondylolisthesis. The patient was provided general anesthesia with oral endotracheal intubation and placed in the prone position with the neck flexed at approximately 10 degrees...

BACKGROUND AND OBJECTIVES: The concept of radiofrequency denervation has recently come under question in light of several studies showing minimal to no benefit. One possibility proposed for these negative outcomes is poor selection criteria. Unlike virtually all other spine interventions, the factors associated with success and failure for cervical facet denervation have yet to be determined. The purpose of this study is to determine which demographic, clinical and treatment factors are associated with cervical facet radiofrequency denervation outcomes...

This case report demonstrates the successful anesthetic management of cesarean section for a 29-year-old primiparous parturient with a past history of a scoliosis operation at 13 years of age. An Isola hook and screw-rod system had been implanted as posterior spinal instrumentation at the level of T3-L3. We titrated hyperbaric bupivacaine 7 mg combined with fentanyl 15 microg through a continuous spinal catheter, placed with a catheter-over-needle technique in order to avoid unintentional wide spread of anesthetic agents...

STUDY DESIGN: Continuous retrospective series. OBJECTIVES: To compare two techniques sequentially used for surgical correction of neuromuscular scoliosis with pelvic obliquity in children with cerebral palsy. SUMMARY OF BACKGROUND DATA: In nonwalking patients with cerebral palsy, scoliosis is frequently associated with pelvic obliquity. We compared intraoperative traction with no traction with instrumentation to the pelvis to correct pelvic obliquity...

STUDY DESIGN: A retrospective chart and radiographic review of patients with a Fontan physiology who underwent surgical correction of their scoliosis. OBJECTIVE: To evaluate the operative and perioperative treatment of patients with a Fontan physiology and scoliosis. SUMMARY OF BACKGROUND DATA: The survival rates in patients with complex congenital heart disease are improving, thus creating a subset of patients with complex physiology who will require surgical treatment of their scoliosis...

STUDY DESIGN: Case report of two children sustaining venous air embolism (VAE) during posterior surgery for scoliosis. OBJECTIVES: To report 2 cases where visible bubbling at the operative site was the first clinical indication of VAE-induced cardiovascular collapse and to raise the level of consciousness that VAE in the prone position can occur, often with serious consequences. SUMMARY OF BACKGROUND DATA: Twenty-two cases of VAE during surgery for scoliosis in the prone position have been reported...

Vertebral operations are highly traumatic, prolonged and can cause significant blood loss, which requires effective anesthesiological defense. Inclusion of clofelin, a stress protector, into the anesthesiological provision scheme is an effective way of potentiating the protection of a patient from surgical stress. The development of neurological disorders is a severest complication during surgical interventions in vertebral surgery. The task that is important for a surgeon and an anesthesiologist in performing such operations is the maximum early recovery of patients from anesthesia and their muscular activity in the postoperative period in order to make a timely evaluation of their neurological status...

STUDY DESIGN: A retrospective comparison of postoperative continuous epidural analgesia and patient-controlled analgesia following surgical treatment for adolescent idiopathic scoliosis. OBJECTIVES: To compare the safety and efficacy of continuous epidural analgesia and patient-controlled analgesia following adolescent idiopathic scoliosis surgery. SUMMARY OF BACKGROUND DATA: The most commonly used pain management techniques are continuous epidural analgesia and patient-controlled analgesia...

BACKGROUND: The study objective was to compare epidural vs intravenous postoperative analgesia in posterior spinal fusion surgery patients. METHODS: This prospective, double-blinded, randomized study was performed in a tertiary care teaching hospital involving 31 American Society of Anesthesiologists physical status I and II adolescent/young adult patients scheduled for elective posterior spinal fusion surgery for idiopathic scoliosis. Patients were divided into three treatment groups according to the epidural solution infused: group 1 (n = 10) 0...