Abstract
Most orthopedic surgery in children involves congenital bony defects and acute fractures. The challenges of these surgeries usually relate to the underlying medical disorders of the children (cerebral palsy, obesity, and others). Surgery for spinal deformities poses the greatest challenges for anesthesiologists. Preoperative assessment requires meticulous attention to pre-existing cardiorespiratory and neuromuscular status. Those with pre-existing myopathies require assessment of their cardiac status in addition to their respiratory status. Currently, motor and somatosensory-evoked potential monitoring are used during spine surgery, necessitating a specific anesthetic prescription that is based on a total intravenous anesthetic. Intraoperative strategies to limit blood loss should be considered particularly in repeat surgeries and children with myopathies including autologous preoperative blood donation, cell-saver, and anti-fibrinolytic therapy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aarons CE, Fernandez MD, Willsey M, et al. Bier block regional anesthesia and casting for forearm fractures: safety in the pediatric emergency department setting. J Pediatr Orthop. 2014;34:45–9.
Abu-Kishk I, Kozer E, Hod-Feins R, et al. Pediatric scoliosis surgery—is postoperative intensive care unit admission really necessary? Paediatr Anaesth. 2013;23(3):271–7.
Anschel DJ, Aherne A, Soto RG, et al. Successful intraoperative spinal cord monitoring during scoliosis surgery using a total intravenous anesthetic regimen including dexmedetomidine. J Clin Neurophysiol. 2008;25(1):56–61.
Baig MN, Lubow M, Immesoette P, et al. Vision loss after spine surgery: review of the literature and recommendations. Neurosurg Focus. 2007;23(5):E15.
Bird GT, Hall M, Nel L, et al. Effectiveness of Arndt endobronchial blockers in pediatric scoliosis surgery: a case series. Paediatr Anaesth. 2007;17(3):289–94.
Boretsky KR. Regional anesthesia in pediatrics: marching forward. Curr Opin Anaesthesiol. 2014;27(5):556–60.
Dadure C, Capdevila X. Peripheral catheter techniques. Paediatr Anaesth. 2012;22(1):93–101.
Dadure C, Bringuier S, Raux O, et al. Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters. Can J Anaesth. 2009;56(11):843–50.
Dalens B. Some current controversies in paediatric regional anaesthesia. Curr Opin Anaesthesiol. 2006;19(3):301–8.
Gibson PR. Anaesthesia for correction of scoliosis in children. Anaesth Intensive Care. 2004;32(4):548–59.
Hiller A, Meretoja OA, Korpela R, et al. The analgesic efficacy of acetaminophen, ketoprofen, or their combination for pediatric surgical patients having soft tissue or orthopedic procedures. Anesth Analg. 2006;102(5):1365–71.
Jain A, Puvanesarajah V, Menga EN, et al. Unplanned hospital readmissions and reoperations after pediatric spinal function surgery. Spine. 2015;40(11):856–62.
Johnson DJ, Chalkiadis GA. Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children? Paediatr Anaesth. 2009;19:83–91.
Johr M. Regional anaesthesia in neonates, infants and children: an educational review. Eur J Anaesthesiol. 2015;32(5):289–97.
Kang GR, Suh SW, Lee IO. Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis. J Orthop Sci. 2011;16(2):139–47.
Lamdan R, Sadun A, Shamir MY. Near-fatal air embolus during arthrography of the hip in a baby aged four months. J Bone Joint Surg Br. 2007;89(2):240–1.
Martin DP, Bhalla T, Thung A, et al. A preliminary study of volatile agents or total intravenous anesthesia for neurophysiological monitoring during posterior spinal fusion in adolescents with idiopathic scoliosis. Spine. 2014;39(22):E1318–24.
Muenster T, Mueller C, Forst J, et al. Anaesthetic management in patients with Duchenne muscular dystrophy undergoing orthopaedic surgery: a review of 232 cases. Eur J Anaesthesiol. 2012;29(10):489–94.
Pelosi L, Lamb J, Grevitt M, et al. Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol. 2002;113(7):1082–91.
Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology. 2012;116(2):274–85.
Roth S. Perioperative visual loss: what do we know, what can we do? Br J Anaesth. 2009;103 Suppl 1:i31–40.
Samdani AF, Belin EJ, Bennett JT, et al. Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors. Eur Spine J. 2016;25:795–800.
Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 2007;89(11):2440–9.
Sethna NF, Zurakowski D, Brustowicz RM, et al. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005;102(4):727–32.
Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009;109(5):1534–45.
Sinicina I, Bise K, Hetterich R, et al. Tourniquet use in childhood: a harmless procedure? Paediatr Anaesth. 2007;17(2):167–70.
Tamkus A, Rice K. The incidence of bite injuries associated with trancranial motor-evoked potential monitoring. Anesth Analg. 2012;115:663–7.
Zhuang Q, Wang S, Zhang J, et al. How to make the best use of intraoperative motor evoked potential monitoring? Experience in 1162 consecutive spinal deformity surgical procedures. Spine. 2014;39(24):E1425–32.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Lerman, J., Coté, C.J., Steward, D.J. (2016). Orthopedic Surgery. In: Manual of Pediatric Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-30684-1_15
Download citation
DOI: https://doi.org/10.1007/978-3-319-30684-1_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-30682-7
Online ISBN: 978-3-319-30684-1
eBook Packages: MedicineMedicine (R0)