Surgery For Kyphoscoliosis Research Articles

Two-Staged Surgery for Kyphoscoliosis in Larsen Syndrome with A 30-Year Follow-Up: A Case Report.

Two-Staged Surgery for Kyphoscoliosis in Larsen Syndrome with A 30-Year Follow-Up: A Case Report.

Patient specific rods in thoracolumbar kyphoscoliosis surgery protect against proximal junctional failure: A prospective observational study

Patient specific rods in thoracolumbar kyphoscoliosis surgery protect against proximal junctional failure: A prospective observational study

High-volume, multilevel local anesthetics-Epinephrine infiltration in kyphoscoliosis surgery: Intra and postoperative analgesia.

Background and Aims:Local anesthetic (LA) infiltration is one of the analgesic techniques employed during scoliosis correction surgery. However, its efficacy is controversial. In the present study for optimizing analgesia using the infiltration technique, we proposed two modifications; first is the preemptive use of high volume infiltration, second is applying three anatomical multilevel infiltrations involving the sensory, motor, and sympathetic innervations consecutively.Material and Methods:This prospective study involved 48 patients randomized into two groups. After general anesthesia (GA), the infiltration group (I) received bupivacaine 0.5% 2 mg/kg, lidocaine 5 mg/kg, and epinephrine 5 mcg/mL of the total volume (100 mL per 10 cm of the wound length) as a preemptive infiltration at three levels; subcutaneous, intramuscular, and the deep neural paravertebral levels, timed before skin incision, muscular dissection, and instrumentation consecutively. The control group (C) received normal saline in the same manner. Data were compared by Mann-Whitney, Chi-square, and t-test as suitable.Results:Intraoperatively, the LA infiltration reduced fentanyl, atracurium, isoflurane, nitroglycerine, and propofol consumption. Postoperatively, there was a 41% reduction in morphine consumption, longer time to the first analgesic request, lower VAS, early ambulation, and hospital discharge with high-patient satisfaction.Conclusion:The preemptive, high-volume, multilevel infiltration provided a significant intra and postoperative analgesia in scoliosis surgery.

Enoxaparin dosing in Noonan syndrome: a case report

AbstractBackgroundNoonan syndrome is a genetic condition that typically includes heart abnormalities and characteristic facial features. Various bleeding disorders have been associated with Noonan syndrome. Some affected individuals have excessive bruising, nosebleeds or prolonged bleeding following injury or surgery. This paper describes anti‐Factor Xa levels following excessive enoxaparin dosing in a male patient with Noonan syndrome.Clinical detailsA 24‐year‐old male (weighing 53 kg) presented under Orthopaedics for his elective three‐stage scoliosis surgery for kyphoscoliosis. The patient was usually on warfarin for a mechanical valve replacement. Bridging enoxaparin was prescribed (initially 1.5 mg/kg, SC, daily), but failure to reach therapeutic anti‐Factor Xa levels (highest level 0.44 units/mL) resulted in escalating enoxaparin doses (90 mg, SC, twice daily).OutcomesDespite a doses of up to 1.7 mg/kg enoxaparin twice daily, the patient did not reach therapeutic anti‐Factor Xa levels according to recommended reference ranges. The patient’s regular warfarin dose was restarted and the enoxaparin was ceased once his International Normalised Ratio was within the therapeutic range. The patient was transferred to a a rehabilitation facility 10 days after surgery.ConclusionMedication assay ranges may not always be an accurate point of reference, particularly when patients present with unusual comorbidities. As health care moves towards patient‐centred care, it is essential that individual patient parameters are considered when monitoring medication treatment plans.

Combined spinal-epidural anesthesia in a patient with spinal muscular atrophy type II undergoing cesarean section: A case report

Introduction. Anesthetic management of a patient with spinal muscular atrophy type II, who underwent elective cesarean section with neuraxial anesthesia is presented in this case report. Case report. A 33-year old woman with first pregnancy and no previous birth, at 39 weeks gestational age was scheduled for a cesarean section due to placenta previa. She had a history of spinal muscular atrophy type II, that confined her to a wheelchair, and a surgical history that included corrective surgery for kyphoscoliosis. The patient had predictors for a difficult intubation (limited mouth opening and reduced neck extension) so the decision was made to attempt the needle-through-needle combined spinal-epidural technique for surgical anesthesia. Harrington rods and scar tissue complicated placement of the combined spinal-epidural anesthesia, however successful placement was achieved. Conclusion. Spinal muscular atrophy in pregnancy is rare and represents big challenge for an anesthesiologist due to respiratory dysfunction, anticipated difficult intubation, severe kyphoscoliosis and limitations of the use neuromuscular blocking agents. The potential risks need to be considered when administering anesthesia in patients with spinal muscular atrophy undergoing a cesarean section.

High-volume, Multilevel Local Anesthetics-Epinephrine Infiltration in Kyphoscoliosis Surgery: Blood Conservation.

Introduction:Scoliosis surgery is usually associated with severe bleeding. Various systemic strategies for blood conservation were applied, while the local techniques get less attention. The preemptive use of sufficient volume for proper tissue infiltration at two levels was applied. The local epinephrine may control bleeding without reliance upon deliberate hypotension, permitting a higher tissue perfusion.Materials and Methods:This prospective study included 46 patients scheduled for posterior spinal fusion for scoliosis correction. Patients were randomized into two groups. group I received a cocktail of high volume (100 ml/each 10 cm of wound length) of local anesthetics and epinephrine tumescent infiltration at the subcutaneous (SC) followed by intramuscular level bilaterally. Group C received saline infiltration in the same technique. Statistically, data were analyzed according to its distribution using the t-test, Mann–Whitney, and Chi-square tests as appropriate.Results:There was a significant reduction in blood loss (38%), reduced blood and fluid transfusion (36% and 23%), and reduced operative time (23%), with higher surgeon satisfaction. The surgical field visibility (Fromme's scale) was much better during SC and muscular dissection in Group I, while it was fair during the bony work. The satisfactory field in spite of higher mean blood pressure in Group I greatly omitted the reliance upon deliberate hypotension.Conclusion:The high-volume multilevel infiltration of epinephrine cocktail can provide a significant blood and operative time conservation in kyphoscoliosis surgery.

Thromboelastography to monitor the intra‐operative effects of low‐molecular weight heparin following bridging anticoagulation in a child with normal renal function*

Paediatric patients who require anticoagulation with therapeutic doses of low-molecular weight heparin are at risk of having a residual anticoagulant effect at the time of surgery, even if managed according to current peri-operative guidelines. Testing for residual effect is not currently recommended in such circumstances. A 15-year-old child with a mechanical aortic valve replacement requiring long-term warfarin treatment, as well as underlying coagulation defects, was administered low-molecular weight heparin for bridging anticoagulation before kyphoscoliosis surgery. Thromboelastography was used intra-operatively to diagnose residual heparinisation, which was demonstrated by a prolonged reaction (R) time of 16.0 min in the plain cup, compared with 9.2 min in the heparinase cup. Subsequently, thromboelastography was also used to monitor haemostatic therapy, which consisted of protamine 2 mg.kg(-1) and 500 IU cryoprecipitate. Thromboelastography was used intra-operatively to allow rapid testing of coagulation status and guide therapy, thereby minimising use of blood products and reducing complications.

Bispectral index and their relation with consciousness of the patients who receive desflurane or sevoflurane anesthesia during wake-up test for spinal surgery for correction

BackgroundWake-up tests may be necessary during surgery for kypho-scoliosis to ensure that spinal function remains intact. It is difficult to predict the time when patients can respond to a verbal command. We evaluated the effectiveness of the bispectral index (BIS) and its relation to patients' levels of consciousness in wake-up tests during desflurane and sevoflurane anesthesia.MethodsEighteen patients each were enrolled in the desflurane and sevoflurane groups for spinal correction surgery. We measured BIS values, blood pressure, heart rate, and consciousness state and time, at the points when patients responded during the wake-up test.ResultsThe BIS values when patients made fists upon a verbal command (T3) were 86.7 ± 7.5 for desflurane and 90.3 ± 5.4 for sevoflurane. Patients in the desflurane group had significantly shorter wake up delays than those in the sevoflurane group (6.9 ± 1.8 min vs. 11.8 ± 3.6 min). However, there was no difference between the groups in the time between the response to a verbal command and the time when a patient moved their toes in response to verbal commands. No recall of the wake-up tests occurred in either group.ConclusionsThe values obtained using the BIS index could to some extent predict the time of a patient's and would be informative during desflurane and sevoflurane anesthesia. Moreover, desflurane permitted faster responses to verbal commands than sevoflurane, and allowed the wake-up test to be performed sooner.

Lesson of the Week: Overdosage of opiate from patient controlled analgesia devices

When Keeri-Szanto described patient controlled analgesia in 1971 he observed that, because a large, potentially fatal amount of a narcotic drug is “hooked up” to the patient, fail safe methods of administering such drugs should be incorporated into the devices used. He suggested for example, that gravity feeding or syphoning should not be used.1 Since then five cases of overdosage from patient controlled analgesia devices that have been correctly set up have been reported.*RF 2-5* We report a case of overdosage in a young girl, which was apparently caused by a fault in the syringe in the patient controlled analgesia device that she was using. Patient controlled analgesia devices must be correctly positioned and include safety features to prevent overdosage A 13 year old girl weighing 48 kg underwent surgery for kyphoscoliosis, in which Harrington rods were implanted in her spine. In the intensive …

Respiratory Mechanics in Anesthetized Young Patients with Kyphoscoliosis: Immediate and Delayed Effects of Corrective Spinal Surgery

To our knowledge, the effects of corrective spinal surgery on total respiratory mechanics and its components in anesthetized patients with kyphoscoliosis have not been previously reported in detail. We studied 13 patients with kyposcoliosis; their mean (+/- SD) age was 24.7 +/- 2.1 years; eight underwent anterior and posterior spinal fusions (AF and PF, respectively) two weeks apart (group A), four underwent PF alone (group B), and one had a three-stage procedure. Mean total respiratory elastance (Ers), static and dynamic lung elastance (Est,L and Edyn,L, respectively), chest wall elastance (Ew), and lung resistance (RL) were derived according to previously described methodology. In group A, Ers and Ew increased by 39 percent and 58 percent, respectively, following AF and by 20 percent and 129 percent following PF, while Est,L and Edyn,L did not change or declined following PF. Lung resistance increased 19 percent and 41 percent by the end of AF and PF, respectively, in group A. In group B, Ew more than doubled, resulting in a 39 percent increase in Ers. Increases in Ers, Ew, and respiratory flow resistance observed at the time of spinal corrective surgery for kyphoscoliosis may result from rib cage trauma and changes in airway caliber related to microatelectasis and uneven distribution of mechanical properties within the lungs. Spinal correction results in immediate and short-term deterioration of respiratory mechanics measured under anesthesia.

THE USE OF SODIUM NITROPRUSSIDE IN CHILDREN

The hypotensive response to sodium nitroprusside was investigated in 30 children, age range 5-15 years, weight range 14-60 kg, who were undergoing spinal surgery for kyphoscoliosis. It was possible to achieve a constant level of satisfactory hypotension within the range 70-80 mmHg systolic arterial pressure using sodium nitroprusside infused at a rate of 10 microng/kg/minute and no serious side effects were experienced at this dose rate.

"BODY-BRACE" ŒSOPHAGITIS, A COMPLICATION OF KYPHOSCOLIOSIS THERAPY

Oesophagitis developed in 4 patients, 3 of whom had scoliosis braces and 1 a body cast after surgery for kyphoscoliosis. Symptoms varied from chronic epigastric pain to gastrointestinal hæmorrhage. Prophylaxis of œsophageal disease in children undergoing correction of scoliosis may prevent severe œsophagitis.

The use of sodium nitroprusside in children.

The hypotensive response to sodium nitroprusside was investigated in 30 children, age range 5-15 years, weight range 14-60 kg, who were undergoing spinal surgery for kyphoscoliosis. It was possible to achieve a constant level of satisfactory hypotension within the range 70-80 mmHg systolic arterial pressure using sodium nitroprusside infused at a rate of 10 microng/kg/minute and no serious side effects were experienced at this dose rate.