Paediatric Spinal Surgery: "The Essentials of Perioperative Management"

The perioperative management of children undergoing corrective spinal surgery is challenging. The major challenges include the extensive nature of surgery, associated comorbidities and the need for neurophysiological monitoring to diagnose any form of intra-operative neurological insult. The pre-operative functional status and the intra-operative events could dictate the requirement for post-operative mechanical ventilation. 

Spine surgeries are performed for varied pathologies, including congenital or idiopathic defects, alignancy, abscesses, trauma, arteriovenous malformations (AVMs) or herniated disc. The paediatric spine is  commonly operated for the surgical correction of scoliosis. Being a complex spinal deformity, scoliosis has an inherent potential to involve the cardio-pulmonary system. The anesthetic management must begin with a focused pre-operative evaluation. The major intra-operative challenges include the maintenance of safe positioning, fluid and temperature balance, blood conservation and spinal cord function monitoring.  Adequate analgesia and ventilation are the primary issues of concern in the postoperative period.