Scoliosis Sx

Scoliosis Sx • Need two stage Sx, 1st anterior approach to release the anterior spinal artery, and diskectomy, the 2nd stage to posterior → instrumentation • The scoliosis could be secondary to muscular disease ( muscular dystrophy) A→ Reflux→ RSI B→ Restrictive lung disease, ↑ risk of PPC (pneumonia, atelectasis) C→ myopathy, arrhythmias D→ avoid Sux Heme→ consider autologus blood donation pre-op • Consult (ICU, Heme), talk to the Pt regarding awake test • Lab:CBC-D, Lytes, BUN, creat, X-match, CXR, PFT, ABG, ECG, Echo if needed • OR: blood in the OR, bear hugger, Art-line, IV wormer • Position: prone→ check all pressure points, and frequent checking • May consider deliberate hypotension if there is no C/I, with that HR will ↑, so consider β -blockers • SSEP: if ↓ latency by 10% or amp by 60% → ↑ BP, ask the surgeon to stop • Volatiles have the least effect on SSEP → See SSEP card • Post-op: pain, PPC, ICU