Objective. To analyze the state of autonomic regulation of the heart rate in patients with adolescent idiopathic scoliosis before the upcoming surgical treatment of spinal deformity.Material and Methods. The study included 30 patients with adolescent idiopathic scoliosis who were admitted for surgical treatment from January to April 2021. There were 28 female and 2 male patients. The heart rate variability (HRV) registration was carried out on the VNS-micro vegetotester, with Poly-Spectrum.NET software, Neurosoft (Russia). The study was conducted for 5 minutes in the supine position and for 5 minutes after the active orthostatic test. Temporal and spectral indicators of heart rate were analyzed.Results. When analyzing HRV at rest, an increase in the temporal indicators of the heart rate and the power of high-frequency wave oscillations was recorded, which indicates both an increased activity of autonomic regulation in general and the predominance of the regulatory influence o of the parasympathetic division of the autonomic nervous system. A decrease in all spectral components during an active orthostatic test and an increase in stress index values by 3.5 times indicate a significant stress of regulatory systems.Conclusion. Analysis of HRV in patients with adolescent idiopathic scoliosis at rest revealed increased autonomic activity with a predominant effect of the parasympathetic division of the autonomic nervous system. The state of exercise-induced energy deficit, registered after an active orthostatic test, indicates a significant preoperative stress of the regulatory systems and refers this category of patients to a group of increased risk of complications associated with hemodynamic instability.
Introduction: Postoperative drain loss can exceed intraoperative blood loss and affect the severity of the patient’s condition. Aim: The objective of the study was to find significant predictors of postoperative blood loss in surgery for idiopathic scoliosis. Materials and methods: We analyzed the data of 140 patients with idiopathic scoliosis. One hundred three patients (group 1) un-derwent Smith-Petersen osteotomy as part of the multilevel pedicle screw fixation; 37 patients (group 2) required no spinal osteotomy. Correlation and regression analysis of the data was performed. Results: There were significant differences between the groups in the number of fixed segments (p<0.001), the volume of intraoperative blood loss (p<0.001), drain loss (p=0.010), and perioperative blood loss (p<0.001). The study showed that spinal osteotomy had no effect on the volume of postoperative blood loss. A univariate regression analysis revealed the following predictors: patient’s body weight −0.3 [−0.4; −0.2] (p<0.001) and intraoperative blood loss expressed as a percentage of circulating blood volume 0.3 [0.2; 0.5] (p<0.001). The predictors established in univariate regression analysis were significant also in the multivariate analysis. Conclusions: The study established the most significant predictors determining the volume of postoperative blood loss in surgery for idiopathic scoliosis: body weight and intraoperative blood loss expressed in percentages of circulating blood volume. A model for pre-dicting the volume of postoperative blood loss was created based on the identified parameters. This model will optimize support for the treatment associated with transfusion during the perioperative period.
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