Anaesthesia for correction of scoliosis in children

Surgical correction of spinal deformities in children presents a challenge to the anaesthetist because of the extensive nature of the surgery, the co-morbidities of the patients and the constraints on anaesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Adolescent idiopathic scoliosis is the most common deformity. Patients with scoliosis secondary to neuromuscular conditions are at greatest risk of perioperative problems, particularly excessive blood loss and respiratory failure. The risk of spinal cord damage can be decreased by the use of intraoperative spinal cord monitoring, particularly monitoring of the lower limb compound muscle action potential evoked by transcranial electrical stimulation. Specific anaesthetic techniques are required for this monitoring to be reliable. Because of concerns about spinal cord perfusion there is now less reliance on induced hypotension and haemodilution to reduce blood loss, with emphasis on proper patient positioning, controlled haemodynamics and antifibrinolytic therapy. Effective postoperative pain management requires a multimodal approach.