Anaesthesia for spinal surgery in children

Abstract

Spinal surgery is performed in children of all age groups. Some of these children will have significant, other medical problems. For most, surgery will be performed in the prone position. Blood loss may be high for some types of surgery, and patients will benefit from use of a blood-sparing technique. Many patients will require spinal cord monitoring to assess cord function and to prevent neurological deficit.

Anterior sagittal anorectoplasty: An alternative to posterior approach in management of congenital vestibular fistula

“…The difficult manoeuvring in jack knife prone position in PSARP makes it mandatory for anaesthesiologists to be vigilant for possible complications viz., accidental extubation, endotracheal tube migration, eye injuries, dislodgement of IV access and monitoring lines, abdominal compression with impaired ventilation, and decreased cardiac output. [4] These disadvantages have been offset by the ASARP technique. ASARP was introduced by Okada in 1992 for treatment of rectovestibular and anovestibular fistula.…”

Management of Congenital Neurological Defects: Anaesthesiologist’s Challenge

“…Abdomen should be kept free by placing chest and hip rolls to facilitate ventilation, decrease intra-abdominal pressure and decrease bleeding from epidural plexus. 5 Excessive neck rotation should be avoided due to possibility of Arnold Chiari Malformation (ACM); 20% of MMC infants with ACM have vocal cord weakness due to lower cranial nerve palsies leading to inspiratory stridor, apnea due to central hypoventilation, swallowing dysfunction, bradycardia, nystagmus, torticollis, upper limb weakness and spasticity. 1 In children with hydrocephalus, macrocephaly may distort normal anatomy of skull, making airway management difficult.…”

“…In addition, it leads to prolonged recovery from neuromuscular block, impairs platelet functions and lead to more incidence of wound infection. 5 It can be prevented by use of overhead warmers in OT, use of warm infusion fluids, covering the child with cotton pads or drapes and use of warming mattresses and hot air warming blanket such as Bair hugger device. 5 Children with hydrocephalus are prone to hypertension and bradycardia (Cushing's response).…”

“…5 It can be prevented by use of overhead warmers in OT, use of warm infusion fluids, covering the child with cotton pads or drapes and use of warming mattresses and hot air warming blanket such as Bair hugger device. 5 Children with hydrocephalus are prone to hypertension and bradycardia (Cushing's response). 6 Intracranial hypertension can be prevented by avoiding hypoxia and hypercapnia, as it causes cerebral vasodilatation and may worsen raised intracranial pressure especially in combination with laryngoscopy and airway manipulation.…”

“…Associated congenital conditions include hydrocephalus (67.4%). 5 macrocephaly leads to difficult airway management in patients of significant hydrocephalus. Brainstem compression may be caused by extension of head during intubation.…”