Anesthesia and postoperative management of spinal deformity surgery in growing children

Ivan Florentino, Ahsan Qadeer

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The number of pediatric scoliosis surgeries is increasing each year due to recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. A clear understanding of the disease processes with their associated changes in cardiovascular and respiratory function, the preservation of spinal cord blood flow, and techniques in monitoring spinal cord integrity are essential for a good outcome. Because scoliosis surgery is multidisciplinary, several teams must work together to assure the best outcome. Care for children with spinal deformities starts well before their admission for surgery. Anesthesia during correction of scoliosis in children must address surgical requirements for positioning and monitoring in addition to taking into consideration the associated comorbidities, age-related pathophysiology, and the potential for blood loss and vascular injury of the spinal cord. Children undergoing correction of spinal deformities present a significant challenge to the pediatric anesthesiologist due to not only the wide spectrum of underlying pathology but also the variable range of age and size. Awareness of the risk of spinal cord injury (SCI) that will affect the function is critical. Expertise in the management of the patients in various positions, prevention of hypothermia secondary to exposure of a large surgical field for a prolong period of time, and severe hemorrhage, which can sometimes exceed the patient’s total blood volume, are required. In the case of correction of spinal deformities, all of those situations may converge, demanding attentive intraoperative monitoring, particularly of spinal function, and an anesthesia plan tailored to maintain appropriate spinal cord perfusion, minimize blood loss, and allow for early awakening and extubation. This chapter reviews spinal blood flow and autoregulation, preoperative assessment, anesthesia care, blood preservation techniques, and postoperative management.

Original languageEnglish (US)
Title of host publicationThe Growing Spine: Management of Spinal Disorders in Young Children, Second Edition
PublisherSpringer Berlin Heidelberg
Pages857-871
Number of pages15
ISBN (Print)9783662482841, 9783662482834
DOIs
StatePublished - Jan 1 2015

Fingerprint

Spinal Cord
Scoliosis
Anesthesia
Blood Preservation
Pediatrics
Intraoperative Monitoring
Spinal Anesthesia
Vascular System Injuries
Sleep Initiation and Maintenance Disorders
Child Care
Secondary Prevention
Blood Volume
Hypothermia
Fetal Blood
Spinal Cord Injuries
Comorbidity
Homeostasis
Perfusion
Pathology
Hemorrhage

Keywords

  • Anesthesia induction
  • Antibiotic prophylaxis
  • Blood conservation
  • Controlled hypotension
  • Hemodynamic instability
  • Hypothermia
  • Intraoperative monitoring
  • Intrathecal morphine
  • Malnutrition
  • One-lung ventilation
  • Patient positioning
  • Preoperative anesthesia evaluation
  • Restrictive lung disease
  • Spinal cord blood flow autoregulation
  • Spinal cord perfusion pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Florentino, I., & Qadeer, A. (2015). Anesthesia and postoperative management of spinal deformity surgery in growing children. In The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition (pp. 857-871). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_51

Anesthesia and postoperative management of spinal deformity surgery in growing children. / Florentino, Ivan; Qadeer, Ahsan.

The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition. Springer Berlin Heidelberg, 2015. p. 857-871.

Research output: Chapter in Book/Report/Conference proceedingChapter

Florentino, I & Qadeer, A 2015, Anesthesia and postoperative management of spinal deformity surgery in growing children. in The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition. Springer Berlin Heidelberg, pp. 857-871. https://doi.org/10.1007/978-3-662-48284-1_51
Florentino I, Qadeer A. Anesthesia and postoperative management of spinal deformity surgery in growing children. In The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition. Springer Berlin Heidelberg. 2015. p. 857-871 https://doi.org/10.1007/978-3-662-48284-1_51
Florentino, Ivan ; Qadeer, Ahsan. / Anesthesia and postoperative management of spinal deformity surgery in growing children. The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition. Springer Berlin Heidelberg, 2015. pp. 857-871
@inbook{dff024245ab64a7c853f4e95c5648f29,
title = "Anesthesia and postoperative management of spinal deformity surgery in growing children",
abstract = "The number of pediatric scoliosis surgeries is increasing each year due to recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. A clear understanding of the disease processes with their associated changes in cardiovascular and respiratory function, the preservation of spinal cord blood flow, and techniques in monitoring spinal cord integrity are essential for a good outcome. Because scoliosis surgery is multidisciplinary, several teams must work together to assure the best outcome. Care for children with spinal deformities starts well before their admission for surgery. Anesthesia during correction of scoliosis in children must address surgical requirements for positioning and monitoring in addition to taking into consideration the associated comorbidities, age-related pathophysiology, and the potential for blood loss and vascular injury of the spinal cord. Children undergoing correction of spinal deformities present a significant challenge to the pediatric anesthesiologist due to not only the wide spectrum of underlying pathology but also the variable range of age and size. Awareness of the risk of spinal cord injury (SCI) that will affect the function is critical. Expertise in the management of the patients in various positions, prevention of hypothermia secondary to exposure of a large surgical field for a prolong period of time, and severe hemorrhage, which can sometimes exceed the patient’s total blood volume, are required. In the case of correction of spinal deformities, all of those situations may converge, demanding attentive intraoperative monitoring, particularly of spinal function, and an anesthesia plan tailored to maintain appropriate spinal cord perfusion, minimize blood loss, and allow for early awakening and extubation. This chapter reviews spinal blood flow and autoregulation, preoperative assessment, anesthesia care, blood preservation techniques, and postoperative management.",
keywords = "Anesthesia induction, Antibiotic prophylaxis, Blood conservation, Controlled hypotension, Hemodynamic instability, Hypothermia, Intraoperative monitoring, Intrathecal morphine, Malnutrition, One-lung ventilation, Patient positioning, Preoperative anesthesia evaluation, Restrictive lung disease, Spinal cord blood flow autoregulation, Spinal cord perfusion pressure",
author = "Ivan Florentino and Ahsan Qadeer",
year = "2015",
month = "1",
day = "1",
doi = "10.1007/978-3-662-48284-1_51",
language = "English (US)",
isbn = "9783662482841",
pages = "857--871",
booktitle = "The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition",
publisher = "Springer Berlin Heidelberg",

}

TY - CHAP

T1 - Anesthesia and postoperative management of spinal deformity surgery in growing children

AU - Florentino, Ivan

AU - Qadeer, Ahsan

PY - 2015/1/1

Y1 - 2015/1/1

N2 - The number of pediatric scoliosis surgeries is increasing each year due to recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. A clear understanding of the disease processes with their associated changes in cardiovascular and respiratory function, the preservation of spinal cord blood flow, and techniques in monitoring spinal cord integrity are essential for a good outcome. Because scoliosis surgery is multidisciplinary, several teams must work together to assure the best outcome. Care for children with spinal deformities starts well before their admission for surgery. Anesthesia during correction of scoliosis in children must address surgical requirements for positioning and monitoring in addition to taking into consideration the associated comorbidities, age-related pathophysiology, and the potential for blood loss and vascular injury of the spinal cord. Children undergoing correction of spinal deformities present a significant challenge to the pediatric anesthesiologist due to not only the wide spectrum of underlying pathology but also the variable range of age and size. Awareness of the risk of spinal cord injury (SCI) that will affect the function is critical. Expertise in the management of the patients in various positions, prevention of hypothermia secondary to exposure of a large surgical field for a prolong period of time, and severe hemorrhage, which can sometimes exceed the patient’s total blood volume, are required. In the case of correction of spinal deformities, all of those situations may converge, demanding attentive intraoperative monitoring, particularly of spinal function, and an anesthesia plan tailored to maintain appropriate spinal cord perfusion, minimize blood loss, and allow for early awakening and extubation. This chapter reviews spinal blood flow and autoregulation, preoperative assessment, anesthesia care, blood preservation techniques, and postoperative management.

AB - The number of pediatric scoliosis surgeries is increasing each year due to recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. A clear understanding of the disease processes with their associated changes in cardiovascular and respiratory function, the preservation of spinal cord blood flow, and techniques in monitoring spinal cord integrity are essential for a good outcome. Because scoliosis surgery is multidisciplinary, several teams must work together to assure the best outcome. Care for children with spinal deformities starts well before their admission for surgery. Anesthesia during correction of scoliosis in children must address surgical requirements for positioning and monitoring in addition to taking into consideration the associated comorbidities, age-related pathophysiology, and the potential for blood loss and vascular injury of the spinal cord. Children undergoing correction of spinal deformities present a significant challenge to the pediatric anesthesiologist due to not only the wide spectrum of underlying pathology but also the variable range of age and size. Awareness of the risk of spinal cord injury (SCI) that will affect the function is critical. Expertise in the management of the patients in various positions, prevention of hypothermia secondary to exposure of a large surgical field for a prolong period of time, and severe hemorrhage, which can sometimes exceed the patient’s total blood volume, are required. In the case of correction of spinal deformities, all of those situations may converge, demanding attentive intraoperative monitoring, particularly of spinal function, and an anesthesia plan tailored to maintain appropriate spinal cord perfusion, minimize blood loss, and allow for early awakening and extubation. This chapter reviews spinal blood flow and autoregulation, preoperative assessment, anesthesia care, blood preservation techniques, and postoperative management.

KW - Anesthesia induction

KW - Antibiotic prophylaxis

KW - Blood conservation

KW - Controlled hypotension

KW - Hemodynamic instability

KW - Hypothermia

KW - Intraoperative monitoring

KW - Intrathecal morphine

KW - Malnutrition

KW - One-lung ventilation

KW - Patient positioning

KW - Preoperative anesthesia evaluation

KW - Restrictive lung disease

KW - Spinal cord blood flow autoregulation

KW - Spinal cord perfusion pressure

UR - http://www.scopus.com/inward/record.url?scp=84957703684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957703684&partnerID=8YFLogxK

U2 - 10.1007/978-3-662-48284-1_51

DO - 10.1007/978-3-662-48284-1_51

M3 - Chapter

AN - SCOPUS:84957703684

SN - 9783662482841

SN - 9783662482834

SP - 857

EP - 871

BT - The Growing Spine: Management of Spinal Disorders in Young Children, Second Edition

PB - Springer Berlin Heidelberg

ER -