Clinical Procedure
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This may be performed as an isolated procedure several weeks before a posterior spinal fusion, to allow time for traction and some improvement in vertebral alignment before the posterior fusion.
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Mar 17, 2012
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An arterial line will be useful to monitor haemodynamics when remifentanil is in use, or where significant bleeding is expected.
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Jun 12, 2013
A double lumen tube is not usually required. Most paediatric surgeons obtain adequate access to the vertebrae by retracting the lung.
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Mar 18, 2012
Watch during transfer into the supine position for dislodgement of lines. The arms will be repositioned from above the head to beside the torso, and will require sufficient slack to avoid being pulled out.
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Pieter Peach
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Mar 17, 2012
Patient may have a halo femoral traction placed at the end of the procedure. In this instance, they will be placed in the supine position.
Cranial fixation pins will be placed, and femoral fixation pins will be drilled into the distal femur. These will be stimulating and require adequate analgesic cover.
Cranial fixation pins will be placed, and femoral fixation pins will be drilled into the distal femur. These will be stimulating and require adequate analgesic cover.
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Mar 16, 2012
Lines: 22g IVC for drug line.
Large bore IVC for volume.
IAL.
IDC.
Propofol-based TIVA or volatile anaesthetic technique.
Neurophysiological monitoring is unlikely to be used in anterior spinal fusion since there generally won't be distraction, but if it is to be used, consider a TIVA technique and avoid neuromuscular block (I don't paralyse patients as a rule, but it's OK to give small dose of atracurium at start to facilitate intubation).
Remifentanil & ketamine infusions.
BIS/Entropy monitor.
Single lumen cuffed ETT.
Postop ketamine infusion plus opioid infusion/PCA, in addition to appropriate oral multimodal analgesia (check with surgeons re: NSAIDs).
Large bore IVC for volume.
IAL.
IDC.
Propofol-based TIVA or volatile anaesthetic technique.
Neurophysiological monitoring is unlikely to be used in anterior spinal fusion since there generally won't be distraction, but if it is to be used, consider a TIVA technique and avoid neuromuscular block (I don't paralyse patients as a rule, but it's OK to give small dose of atracurium at start to facilitate intubation).
Remifentanil & ketamine infusions.
BIS/Entropy monitor.
Single lumen cuffed ETT.
Postop ketamine infusion plus opioid infusion/PCA, in addition to appropriate oral multimodal analgesia (check with surgeons re: NSAIDs).
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Jun 12, 2013