Orthopedic and Spine Surgery

Abstract

© 2019 Elsevier Inc. All rights reserved. Anesthesia for orthopedic and spine surgery provides a multitude of challenges. Children often present with concomitant diseases that affect cardiovascular and respiratory function. Operating times can be protracted, particularly for scoliosis surgery. Many of these procedures involve children already severely compromised by muscle weakness and impaired respiratory function. Improvement in monitoring of spinal cord function help minimize neurological risk. Significant blood loss can occur that requires strategies for blood product management and transfusion reduction. Major trauma causing orthopedic injuries invariably involves other organ systems that may adversely interact with or compromise anesthesia management. The risks of pulmonary aspiration of gastric contents and the requisite fasting times, after even minor trauma involving an isolated forearm fracture, continue to be debated. Fat embolus is uncommon in children with long-bone fractures but should be considered in any child with hypoxia and altered consciousness in the perioperative period. Tumor surgery may be complicated by chemotherapy, altered drug disposition, or bone grafting considerations akin to those for plastic and reconstructive surgery and complex postoperative pain management may be required. Positioning children on the operating table involves care, especially for those with limb deformities and contractures. Patients with a variety of syndromes also require other orthopedic procedures to assist in minimizing the impact of those syndromes on their quality of life. These syndromes present their own unique anesthetic challenges. The anesthesiologist's role facilitating surgery and providing optimal postoperative care, particularly pain management, should not be underestimated.