Anesthesia is initially started with IV medication or, in younger children, by giving gas through an anesthesia mask. Once your child is asleep, we take additional steps to ensure his or her safety and well-being. These include placement of a breathing tube and additional intravenous (IV) lines.
We use a variety of monitors to check on the heart's electrical activity, oxygen levels in the blood and breathing.
In addition, because it is vital that we carefully monitor blood pressure during your child's spine surgery, a special blood pressure monitor (an arterial line) is placed after your child goes to sleep.
An arterial line is like a regular IV, but it is placed in an artery rather than a vein (usually in the wrist). This allows us to carefully monitor your child's blood pressure, as well as allowing us to draw blood samples for laboratory tests.
The arterial line will remain in place for the period immediately after surgery.
The medications given during surgery are designed to promote deep sleep, to provide excellent pain relief and to relax the muscles during surgery.
Many anesthetic agents are used for spinal surgery, including anesthetic gases and intravenous drugs. Your anesthesiologist will choose the best type of anesthetic based on your child's needs.
These medications are also designed to avoid interfering with spinal cord and nerve function monitoring that may occur during your child's surgery. This special monitoring is known as neurophysiologic monitoring.
Neurophysiologic monitoring involves the placement of special monitoring electrodes on the patient, usually after they are asleep. While your child is asleep, the neurophysiologist constantly monitors several nervous system functions so that potential problems are immediately recognized.
When neurophysiologic monitoring is utilized, the anesthesiologist will work with the neurophysiologist and surgeon to provide an anesthetic which does not significantly interfere with monitoring, yet keeps your child safe and comfortable.
The anesthesiologist, surgeon and neurophysiologist are in constant communication to help insure that potential problems are identified immediately and the appropriate action is taken.
Wake Up Test
As part of the monitoring of nerve function, a "wake up" test may be performed. In this test, the anesthetic is lightened to see if your child is able to move his or her feet in response to a verbal command. This test typically takes less than five minutes.
The anesthetic is then deepened until your child wakes up after the surgery is completed. The wake up test is not uncomfortable for your child and is usually not remembered after surgery.
It is not uncommon for children to require blood transfusions during spinal surgery. This is particularly true if your child has nerve or muscle disease that has resulted in curvature of the spine.
Some children will have the opportunity to donate their own blood to the blood bank before their surgical procedure. This blood will then be given back to the child as needed in the operating room.
At other times, this type of self-directed blood transfusion will not be possible. Your anesthesiologist will monitor your child carefully to determine when a blood transfusion is needed.
While we make every effort to minimize the use of blood transfusion in the operating room, your child's health and well-being is our top priority.