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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

Scoliosis

Gabriella Bluett-Mills

March 8, 2012

scoliosis curve
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
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
3 major problems
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
3 major problems1
3 Major problems
  • Chronic hypoxemia
    • PTN and corpulmonale
    • EKG changes
      • RVH
      • RBBB
      • Righ axis deviation
3 major problems2
3 Major problems
  • Mitral valve prolapse seen in 25% of children affected
prop evaluation
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
intraoperative care
Intraoperative Care
  • Avoid N20 since it can worsen PTN
  • CVP monitoring to assess fluid status
  • Be prepared for pneumothorax
postop course
Postop course
  • Ventilatory weaning postop should be slow and cautious
  • If vital capacity is <40%, postop ventilation is necessary
harrington rod complications
Harrington Rod complications
  • Paralysis
  • Hemorrhage
  • Fat and air embolism
  • Pneumothorax
hypotensive anesthesia
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
wake up test
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
autologous blood donation
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