Scoliosis Correction - Clinical Case

17 january 2018
Смирнов Игорь Валерьевич
анестезиолог-реаниматолог

Clinical review

Features of the management of the perioperative period in patients with decompensated scoliosis through the eyes of an anesthesiologist.

Leading physician anesthesiologist-resuscitator Smirnov I.V.

Main problems

  • Patient's physical condition
  • Airway management
  • Providing vascular access
  • Intraoperative position on the operating table
  • Hemostasiological disorders
  • Cardiac complications
  • Respiratory disorders.

Patient's physical condition

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Airway Management - Insufficient Neck Extension

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Possible solutions to the problem:
  • Use of endoscopic techniques for intubation
  • Thorough assessment of airway anatomy before surgery
  • Predicting difficult intubation using the Mallampati scale.

Providing Vascular Access - Abnormal Arrangement of Vessels

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Possible solutions to the problem:
  • Use of ultrasound navigation for central venous catheter and arterial cannula placement.
  • Intraoperative position on the operating table - increased pressure in the abdominal cavity and increased intraoperative bleeding due to increased pressure in the epidural space.

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Possible solutions:
  • Use of cushion rollers to relieve abdominal pressure.

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Prolonged forced position

Increased risk of plexitis, compression damage to the eyes.

Possible solutions to the problem:
  • Careful positioning of the patient on the operating table
  • Use of anatomical gel rolls.

Hemostasiological disorders - large volume of blood loss

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Possible solutions to the problem:
  • use of blood-saving technologies.

Cardiac complications

  • Johns Hopkins Children's Center and Texas Scottish Rite Hospital for Children in Dallas (TSRHC)
  • 2004-2014
  • 2639 operations for scoliosis.

The risk of heart attack in children during spinal surgery is extremely low: attacks were recorded in only 11 patients (of which one patient died, ten children were successfully resuscitated) out of 2639 operated, which is less than 0.5%.

  • Six out of eleven children who had a heart attack had neuromuscular disorders)
  • In eight out of eleven cases, cardiac arrest was caused by electrolyte imbalance
  • Allergic and anaphylactic reactions, arrhythmias, respiratory complications and airway problems.

Respiratory Disorders

  • Decreased cough reflex
  • Anatomical features of the respiratory tract
  • Decreased muscle strength

Possible solutions:
  • Using a cough and non-invasive ventilation.
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Results obtained

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