Anesthesia and postoperative management of spinal deformity surgery in growing children

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.