Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset ScoliosisReport as inadecuate

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Study Design: A prospective, observational caseseries of eighteen children with early onset scoliosis undergo spinemanipulation and casting. Objective: Determine if respiratory system compliancedecreases during casting warrantstracheal intubation in all Derotational casting procedures. Background:Children with early onset scoliosis with aCobb angle greater than 25 degrees will have significant progression of theirscoliosis. Surgical techniques cannotresult in spine fusion as growth retardation will ensue. Serial thoracolumbarcasting may correct the scoliosis or delay the need for surgery. The cast,however, is highly restrictive until the cast is appropriately cut. Doesrespiratory system compliance decrease a significant degree to require trachealintubation in all Derotationalcasting procedures? Methods: Eighteen children mean age: 4.5 years, meanweight: 16.9 kg undergoing initial scoliosis casting were enrolled. Anesthesiawas induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofoladministered and tracheal intubation performed. Baseline measurements of heartrate, blood pressure, SpO2, peak inspiratory pressure PIP, andpulmonary compliance were made before casting,immediately after casting, and after cast cut-out. Results: PIP increased from15.8 cm H2O to 42.6 after cast application and decreased to 20.2after cast cut-out. Compliance decreased from 1.08 ml-cm H2O-kg to0.21 after cast application and increased to 0.61 after cast cut-out. Therewere no clinically significant changes in heart rate, blood pressure, or SpO2.Conclusion: The thoracolumbar cast applied for scoliosis treatment causessevere restriction of chest wall movement and subsequent deterioration ofpulmonary function. The time of severerestriction of chest wall motion is short and is relieved once cast cut-outsare performed. The marked increase in PIPand decrease in compliance that occurs during the casting process necessitatestracheal intubation.


Derotational Casting; Early Onset Scoliosis; Respiratory Compliance

Cite this paper

R. Jensen, A. Stasic, S. Kishan, E. Scott, D. Martin and S. Dierdorf -Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis,- Open Journal of Anesthesiology, Vol. 4 No. 2, 2014, pp. 36-40. doi: 10.4236-ojanes.2014.42005.

Author: Robin D. Jensen, Andrew F. Stasic, Shyam Kishan, Eric Scott, Deann M. Martin, Stephen F. Dierdorf



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