How is Anesthesia Used During Spine Surgery?
General anesthesia is administered for surgical repair of curvature of the spine (scoliosis).
There are two types of spinal curvature that require surgical correction. The first, sometimes called idiopathic scoliosis, occurs when the spine curves abnormally for unknown reasons.
The second type of curvature is usually associated with other diseases that affect your child's muscles, nerves and bones.
Surgical Procedure for Scoliosis
There are many surgical procedures for children with scoliosis that are performed at Cincinnati Children's. These include:
- Procedures that allow the spine to be straightened
- The use of surgical instruments, which stop the further progression of spinal curvature
- The use of video cameras to minimize the scarring and discomfort associated with spine surgery
Procedures will sometimes take place during a single operation. At other times, orthopaedic surgeons choose to perform more than one surgical procedure on two separate dates. Anesthesiologists' concerns during this type of surgery include:
- Appropriate monitoring of your child's vital signs
- Proper positioning for surgery
- Control of your child's blood pressure
- Management of blood loss
- Fluid replacement
- Monitoring of your child's spinal cord and nerve function
- Pain management after surgery
Before Spine Surgery
Your anesthesiologist will meet with you and your child on the day of surgery. Some children with complex medical problems may be required to meet with an anesthesiologist prior to the surgical date.
You will be asked to answer questions about your child's medical history, allergies, current medications, previous anesthetic experience and current health status.
Your child's airway, heart and lungs will be examined carefully. Your anesthesiologist will then discuss with you the anesthetic plan for your child. You will also meet with a member of the pain management team to discuss a strategy to assure your child is comfortable after surgery.
Sometimes we will give a medication either by mouth or intravenously (IV) before surgery to help your child relax before coming to the operating room. This medication also provides amnesia, so your child does not remember the stress of getting ready for surgery.
During Spine Surgery
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.
Arterial Line
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.
Medications
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.
Blood Transfusions
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.
After Surgery
After surgery, some children are awakened immediately in the operating room when the surgery is finished. Others must be kept asleep after surgery, usually no more than one to two days.
Under these circumstances, children will remain deeply asleep with their breathing tube in place and will require a ventilator.
If your child is still sleeping or a decision has been made by the orthopaedic surgeon to admit your child to the Pediatric Intensive Care Unit (PICU), your child will be transferred directly from the operating room to PICU for careful monitoring.
When your child is awakened and meets the criteria, he or she will be transferred to the post-anesthesia recovery room (PACU) and eventually to his or her assigned room. While in PACU, your child’s care will be directed by an anesthesiologist, an orthopaedic surgeon and PACU nurses. When your child is transferred to an inpatient room, care will be directed by the orthopaedic surgeon and assigned nurses.
A member of the anesthesia team will visit the day after surgery to make sure that you and your child were pleased with the anesthesia care you received while in our operating room.
