Scoliosis
Considerations
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Etiology: idiopathic vs. non-idiopathic:
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Associated comorbidities (Marfan’s, NF Scheurmann’s disease, DMD, congenital)
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Potential difficult airway secondary to back curvature, neck involvement
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Restrictive lung disease:
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pHTN with cor pulmonale; postop respiratory failure; prolonged ventilation
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Cardiac involvement with idiopathic (MVP), Duchenne muscular dystrophy (CM, coarctation, CHD)
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Surgical consideration: worse for kyphoscoliosis
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Blood loss; hypothermia; airway edema;
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Positioning:
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Prone: VAE, positioning injuries, POVL
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Lateral: OLV if thoracic approach
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Monitoring: wake-up test/SSEP/MEP’s
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Post-op pain control: clonidine, gabapentin, ketamine, opioids
Goals/Conflicts
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Avoid exacerbations of pHTN (hypoxemia, hypercarbia, acidosis, hypothermia, light anesthesia & pain)
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Balance perfusion pressure to spinal cord vs. need for mild hypotension to minimize blood loss:
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TXA, cell saver
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Manage anesthetic agents to allow adequate monitoring of spinal cord integrity (SSEPs/MEPs)
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Vigilance for life threatening complications of VAE or major vascular injury
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Optimize for postoperative wean from ventilation:
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Dexmedetomidine, ketamine, acetaminophen, morphine infusions
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