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Scoliosis

Scoliosis. Gabriella 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.

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Scoliosis

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  1. Scoliosis Gabriella Bluett-Mills March 8, 2012

  2. Scoliosis Curve • Usually right sided • Generally involves 7-10 vertebrae • >100 causes severe cardiac and respiratory dysfuction • <65 respiratory impairment is minimal

  3. 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

  4. 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

  5. 3 Major problems • Chronic hypoxemia • PTN and corpulmonale • EKG changes • RVH • RBBB • Righ axis deviation

  6. 3 Major problems • Mitral valve prolapse seen in 25% of children affected

  7. 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

  8. Intraoperative Care • Avoid N20 since it can worsen PTN • CVP monitoring to assess fluid status • Be prepared for pneumothorax

  9. Postop course • Ventilatory weaning postop should be slow and cautious • If vital capacity is <40%, postop ventilation is necessary

  10. Harrington Rod complications • Paralysis • Hemorrhage • Fat and air embolism • Pneumothorax

  11. 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

  12. 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

  13. 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

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