Posterior spinal fusion
Clinical Procedure
 
Aliases:
Posterior spinal instrumentation

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Discuss the potential for blood transfusion.

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May 11, 2012
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SSEPs and MEPs will be monitored in patients with intact motor function (predominantly idiopathic scoliosis)

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Dec 04, 2012
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A central line should be considered in patients with a significant spinal deformity (usually cerebral palsy, duchenne's, and spinal muscular-atrophy) in which an extensive procedure with significant blood loss is expected.

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Nov 16, 2012
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An arterial line will be required in all patients undergoing this procedure to monitor haemodynamics in the context of moderate to severe blood loss.

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Nov 16, 2012
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Neurophysiological monitoring - somatosensory evoked potentials ( SSEPs) and motor evoked potentials ( MEPs) - may be utilised during the case. If muscle relaxant is used at induction it should be allowed to wear off.

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Mar 14, 2013
Or, avoid muscle relaxants altogether.
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Tranexamic acid will usually be used to help to reduce blood loss.

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Jul 10, 2012
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Prone position

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Normal cuffed ETT works well for prone position. No need for special expensive ETTs.
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If your patient has long hair consider tying it back at the time of induction. It will interfere with any procedures you perform around the head and neck including central line insertion.

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Clonidine will help stabilise intraoperative hemodynamic fluctuations.

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Jun 14, 2013
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Remifentanil infusion may help with endotracheal tube tolerance in abscence of muscle relaxation.

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Remifentanil infusion may help with providing induced hypotension at times of excessive bleeding.

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Book cell saver

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Potential for significant blood loss. Ensure a valid cross match has been obtained and blood is available.

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Mar 17, 2012
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Two large bore volume lines
Arterial line
Central line if significant abnormality with significant expected blood loss.(eg CP patients)
Avoid muscle relaxants at induction in children at induction if SSEP or MEP monitoring to be performed (eg patients with idiopathic scoliosis and intact motor function), or allow the muscle relaxant to wear off.
Propofol TIVA
BIS
Remifentanil infusion
Ketamine infusion
TXA bolus and infusion
Morphine, Paracetamol, Diazepam (0.025-0.05/kg IV) at the end of the case
Postop ketamine infusion and opiate PCA or infusion.

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