Orthopedic surgery is a common reason for anesthesia in children. Reduction of fractures is most often required in children who are otherwise well, but may be at risk of regurgitation of stomach contents and aspiration. An adequate depth of anesthesia reduces the risk of this in children who are not intubated. Stratification of the risk of aspiration can be attempted by considering several factors. Supracondylar fractures frequently require opioid analgesia, and tend to be brought to theater sooner than children with forearm fractures. These children are more at risk of aspiration, and are more commonly intubated. Children with cerebral palsy often require orthopedic surgery to correct hip dysplasia, relieve limb contractures and improve posture, and to improve gait. Pain after surgery can be significant. Scoliosis surgery is performed in specialist centers. Some children have secondary scoliosis caused by neuromuscular disease. Surgery is often to improve posture. Pulmonary function during and after surgery are significant concerns. Spinal cord monitoring may be used during the surgery, and this is affected by many anesthetic drugs, including volatile agents and propofol.
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