[Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity].
Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity--such as neuromuscular disease--are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient's total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success.
Colomina
M J
MJ
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Unidad de Estudio para la Patología del Raquis, Hospital Universitario Vall d'Hebron, Area de Traumatología, Barcelona. 26750mjc@comb.es
Godet
C
C
D000758:Anesthesia / Q000379:methods*; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D002916:Chylothorax / Q000209:etiology / Q000517:prevention & control; D015897:Comorbidity; D005073:Evoked Potentials, Somatosensory; D006331:Heart Diseases / Q000209:etiology; D006334:Heart Function Tests; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D009468:Neuromuscular Diseases / Q000150:complications; D010348:Patient Care Team; D010808:Physical Examination; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011659:Pulmonary Gas Exchange; D012120:Respiration Disorders / Q000209:etiology; D012121:Respiration, Artificial; D018570:Risk Assessment; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013924:Thrombophlebitis / Q000209:etiology / Q000517:prevention & control