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Management of Patient with Scoliosis

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Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care

Abstract

Surgery for correction of pediatric scoliosis typically involves an extensive multilevel instrumented fusion of the spine and is associated with a risk of major blood loss, hemodynamic instability, increased transfusion requirements, neurological injury, postoperative pulmonary dysfunction, and positioning-related complications. Complexity of the surgery, as well as the incidence and severity of complications, is higher in patients with nonidiopathic scoliosis (e.g., neuromuscular scoliosis, congenital scoliosis) as compared to those with adolescent idiopathic scoliosis. Perioperatively, the neuroanesthetist takes several perioperative measures to decrease the incidence of these complications, including a comprehensive preoperative evaluation for detection of potential risk factors; preoperative optimization of modifiable risk factors such as cardiopulmonary dysfunction, anemia, and poor nutritional status; intraoperative administration of antifibrinolytics and “targeted blood pressure management” for reduction of intraoperative blood loss; implementation of “spinal cord protection measures” and multimodality neuromonitoring for preservation of the neurologic integrity; and meticulous postoperative care with a multimodal pain relief and an early mobilization strategy. The choice of anesthetic drugs for these surgeries is largely determined by their compatibility with neuroelectrophysiological monitoring. Patients with nonidiopathic scoliosis merit a more intensive and multidisciplinary approach, for a better clinical outcome.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College and Affiliated Hospitals, Delhi University, New Delhi, India

    Monica S. Tandon

  2. Department of Anesthesia, Max Super-specialty Hospital, Ghaziabad, India

    Aastha Dhingra

  3. Department of Orthopedics, Lok Nayak Jai Prakash Narayan Hospital, Maulana Azad Medical College and Affiliated Hospitals, Delhi University, New Delhi, India

    Vineeth Varma

Authors
  1. Monica S. Tandon
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  2. Aastha Dhingra
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  3. Vineeth Varma
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Editors and Affiliations

  1. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Hemanshu Prabhakar

  2. Vice chair for education & Associate Director of Neuroanesthesiology, Allegheny Health Network, Pittsburgh, PA, USA

    Shobana Rajan

  3. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Indu Kapoor

  4. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Charu Mahajan

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Tandon, M.S., Dhingra, A., Varma, V. (2020). Management of Patient with Scoliosis. In: Prabhakar, H., Rajan, S., Kapoor, I., Mahajan, C. (eds) Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-0458-7_22

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