1 / 13

Scoliosis

Scoliosis. Gabriella Bluett -Mills March 8, 2012. Scoliosis Curve. Usually right sided Generally involves 7-10 vertebrae >100 causes severe cardiac and respiratory dysfuction <65 respiratory impairment is minimal. Scoliosis and Lung Disease.

cody
Download Presentation

Scoliosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scoliosis Gabriella Bluett-Mills March 8, 2012

  2. Scoliosis Curve • Usually right sided • Generally involves 7-10 vertebrae • >100 causes severe cardiac and respiratory dysfuction • <65 respiratory impairment is minimal

  3. Scoliosis and Lung Disease • Scoliosis causes restrictive lung disease by lateral rotation of the spine. • Can be idiopathic or secondary to neuromuscular disease. • If vital capacity is >70%, respiratory reserve should be adequate postop • If vital capacity is <40%, postop ventilation will probably be necessary

  4. 3 Major problems • Restrictive lung disease • Causes increased A-a gradient, alveolar hypoventilation, and hypoxemia • PaCo2 is usually normal • ↓ vital capacity, ↓ TLC, ↓ RV, ↓ FRC,↑Vd/Vt • ↓ FEV1, ↓FVC, normal FEV1/FEC

  5. 3 Major problems • Chronic hypoxemia • PTN and corpulmonale • EKG changes • RVH • RBBB • Righ axis deviation

  6. 3 Major problems • Mitral valve prolapse seen in 25% of children affected

  7. Prop evaluation • Tests • PFTs • ABG- hypoxemia, hypercarbia, acidosis exacerbate PTN • CXR to check for signs of chronic aspiration pneumonia • Treat infection/bronchospasm prior to surgery • Obtain autologous blood

  8. Intraoperative Care • Avoid N20 since it can worsen PTN • CVP monitoring to assess fluid status • Be prepared for pneumothorax

  9. Postop course • Ventilatory weaning postop should be slow and cautious • If vital capacity is <40%, postop ventilation is necessary

  10. Harrington Rod complications • Paralysis • Hemorrhage • Fat and air embolism • Pneumothorax

  11. Hypotensive anesthesia • Propanalol and captoril decrease total dose of SNP • Sodium nitroprusside generally preferable to nitroglycerin for reliable and sustained induction of hypotension in children and adolescents • Labetalol is effective and not associated with tachycardia, intrapulmonary shunt or increased CO

  12. Wake-up test • After a narcotic base is established small increments of naloxone are administered until the patient responds to verbal commands and moves lower extremities • Assistant holds the head and ET tube

  13. Autologous blood donation • Minimizes need for donor blood • Begin three weeks before operation, with 4-7 days between collections to allow for adjustment in blood volume

More Related