Scoliosis Correction - Clinical Case

17 january 2018
Смирнов Игорь Валерьевич

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


Airway Management - Insufficient Neck Extension


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


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.


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


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


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.

Results obtained