Scoliosis Correction - Clinical Case
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
![scolioz1.jpg scolioz1.jpg](/upload/medialibrary/e9f/scolioz1.jpg)
![scolioz2.jpg scolioz2.jpg](/upload/medialibrary/3fa/scolioz2.jpg)
![scolioz3.jpg scolioz3.jpg](/upload/medialibrary/4a0/scolioz3.jpg)
![scolioz4.jpg scolioz4.jpg](/upload/medialibrary/9cd/scolioz4.jpg)
Airway Management - Insufficient Neck Extension
![scolioz5.jpg scolioz5.jpg](/upload/medialibrary/486/scolioz5.jpg)
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
![scolioz6.jpg scolioz6.jpg](/upload/medialibrary/790/scolioz6.jpg)
![scolioz7.jpg scolioz7.jpg](/upload/medialibrary/92a/scolioz7.jpg)
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.
![scolioz8.jpg scolioz8.jpg](/upload/medialibrary/1d4/scolioz8.jpg)
Possible solutions:
- Use of cushion rollers to relieve abdominal pressure.
![scolioz9.jpg scolioz9.jpg](/upload/medialibrary/b98/scolioz9.jpg)
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
![scolioz10.jpg scolioz10.jpg](/upload/medialibrary/683/scolioz10.jpg)
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.
![scolioz12.jpg scolioz12.jpg](/upload/medialibrary/4f6/scolioz12.jpg)
Results obtained
![scolioz3.jpg scolioz3.jpg](/upload/medialibrary/4a0/scolioz3.jpg)
![scolioz14.jpg scolioz14.jpg](/upload/medialibrary/3de/scolioz14.jpg)