Scoliosis 

 

 

Considerations

 

  • Etiology: idiopathic vs. non-idiopathic:

    • Associated comorbidities (Marfan’s, NF Scheurmann’s disease, DMD, congenital)

  • Potential difficult airway secondary to back curvature, neck involvement

  • Restrictive lung disease: 

    • pHTN with cor pulmonale; postop respiratory failure; prolonged ventilation

  • Cardiac involvement with idiopathic (MVP), Duchenne muscular dystrophy (CM, coarctation, CHD)

  • Surgical consideration: worse for kyphoscoliosis 

    • Blood loss; hypothermia; airway edema;

    • Positioning:

      • Prone: VAE, positioning injuries, POVL

      • Lateral: OLV if thoracic approach

    • Monitoring: wake-up test/SSEP/MEP’s

  • Post-op pain control: clonidine, gabapentin, ketamine, opioids

 

 

Goals/Conflicts

 

  • Avoid exacerbations of pHTN (hypoxemia, hypercarbia, acidosis, hypothermia, light anesthesia & pain)

  • Balance perfusion pressure to spinal cord vs. need for mild hypotension to minimize blood loss:

    • TXA, cell saver

  • Manage anesthetic agents to allow adequate monitoring of spinal cord integrity (SSEPs/MEPs)

  • Vigilance for life threatening complications of VAE or major vascular injury

  • Optimize for postoperative wean from ventilation:

    • Dexmedetomidine, ketamine, acetaminophen, morphine infusions