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INVESTIGATIONS

INVESTIGATIONS. Severe scoliosis: PFT ABG Onset in 1 st 8 years: PFT ABG ECG ECHO PAC (if PAH). Onset in 1 st 8 years: PFT ABG ECG ECHO PAC (if PAH) Inv for other co existing ds. Bedside pfts. Breath holding test Match- stick test Bed- side spirometry.

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INVESTIGATIONS

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  1. INVESTIGATIONS • Severe scoliosis: • PFT • ABG • Onset in 1st 8 years: • PFT • ABG • ECG • ECHO • PAC (if PAH)

  2. Onset in 1st 8 years: • PFT • ABG • ECG • ECHO • PAC (if PAH) • Inv for other co existing ds

  3. Bedside pfts • Breath holding test • Match- stick test • Bed- side spirometry

  4. PFTs IN SCOLIOSIS AND IMPLICATIONS

  5. PRE- OPERATIVE PREPARATION • PHYSIOLOGICAL: • Teaching coughing and incentive spirometry • PSYCHOLOGICAL: • If intra- op wake up test is planned- • Inform, reassure, rehearse

  6. Pre-op medications: • Bronchodilators- if coexisting OAD • Mild sedation • Avoid if- Neuromuscular disease, PAH, Impaired gas exchange, markedly reduced PFTs • Anti-sialogogue- Prone position

  7. INFORMED CONSENT • For surgery • Post op ventilation • Explain neurological and respiratory complications

  8. INTRA OPERATIVE MANAGEMENT • MONITORS: STANDARD MONITORS: • NIBP • ECG • Pulse oximetry • ETCO2 • Esophageal stethoscope • Core temperature • Spinal cord monitoring

  9. Additional : • Radial artery catheter-(Allen’s test) • Blood sampling • Arterial pressure for induced hypotension • CVC • PACFoley’s catheter • NMT • BIS or entropy • SSEPs or MEPs

  10. INTRA- OPERATIVE CONSIDERATIONS • AIRWAY- CERVICAL SCOLIOSIS: (FIXED FLEXION DEFORMITY) • Assessment • Difficult aiway cart • Stylets, Bougies, ILMAs • Fibreoptic intubation

  11. ANESTHETIC TECHNIQUE: • Induction- i.v inductional agents ( avoid ketamine) • Muscle –relaxants- Non-depolarising relaxants • Maintenance- O2 + N2O + inhalational • (or) opioid infusion + O2 + N2O + inhalational <0.5 MAC • Warm IV fluids • Forced- air warming systems

  12. PRONE POSITION: • Anti sialogogue • Flexo-metallic ETT • Oro-pharyngeal packing • Tube fixation • Eye pads • Abdomen- pressure free • Padding peripheral nerves • Avoid hyper-abduction at shoulder joint • Constant monitoring of ETT and IV access • (Can move with surgical instrumentation)

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