SCOLIOSISGabriella Bluett-Mills

March 8, 2012

Scoliosis Curve

Usually right sided Generally involves 7-10 vertebrae >100 causes severe cardiac and

respiratory dysfuction <65 respiratory impairment is minimal

Scoliosis and Lung Disease

Scoliosis causes restrictive lung disease by lateral rotation of the spine.

Can be idiopathic or secondary to neuromuscular disease.

If vital capacity is >70%, respiratory reserve should be adequate postop

If vital capacity is <40%, postop ventilation will probably be necessary

3 Major problems

Restrictive lung disease Causes increased A-a gradient, alveolar

hypoventilation, and hypoxemia PaCo2 is usually normal ↓ vital capacity, ↓ TLC, ↓ RV, ↓ FRC,↑Vd/Vt ↓ FEV1, ↓FVC, normal FEV1/FEC

3 Major problems

Chronic hypoxemia PTN and cor pulmonale EKG changes

RVH RBBB Righ axis deviation

3 Major problems

Mitral valve prolapse seen in 25% of children affected

Prop evaluation

Tests PFTs ABG- hypoxemia, hypercarbia, acidosis

exacerbate PTN CXR to check for signs of chronic aspiration

pneumonia Treat infection/bronchospasm prior to

surgery Obtain autologous blood

Intraoperative Care

Avoid N20 since it can worsen PTN CVP monitoring to assess fluid status Be prepared for pneumothorax

Postop course

Ventilatory weaning postop should be slow and cautious

If vital capacity is <40%, postop ventilation is necessary

Harrington Rod complications

Paralysis Hemorrhage Fat and air embolism Pneumothorax

Hypotensive anesthesia

Propanalol and captoril decrease total dose of SNP

Sodium nitroprusside generally preferable to nitroglycerin for reliable and sustained induction of hypotension in children and adolescents

Labetalol is effective and not associated with tachycardia, intrapulmonary shunt or increased CO

Wake-up test

After a narcotic base is established small increments of naloxone are administered until the patient responds to verbal commands and moves lower extremities

Assistant holds the head and ET tube

Autologous blood donation

Minimizes need for donor blood Begin three weeks before operation, with

4-7 days between collections to allow for adjustment in blood volume