TITLE:
Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis
AUTHORS:
Robin D. Jensen, Andrew F. Stasic, Shyam Kishan, Eric Scott, Deann M. Martin, Stephen F. Dierdorf
KEYWORDS:
Derotational Casting; Early Onset Scoliosis; Respiratory Compliance
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.4 No.2,
January
29,
2014
ABSTRACT:
Study Design: A prospective, observational case
series of eighteen children with early onset scoliosis undergo spine
manipulation and casting. Objective: Determine if respiratory system compliance
decreases during casting warrants
tracheal intubation in all Derotational casting procedures. Background:
Children with early onset scoliosis with a
Cobb angle greater than 25 degrees will have significant progression of their
scoliosis. Surgical techniques cannot
result in spine fusion as growth retardation will ensue. Serial thoracolumbar
casting may correct the scoliosis or delay the need for surgery. The cast,
however, is highly restrictive until the cast is appropriately cut. Does
respiratory system compliance decrease a significant degree to require tracheal
intubation in all Derotational
casting procedures? Methods: Eighteen children (mean age: 4.5 years, mean
weight: 16.9 kg) undergoing initial scoliosis casting were enrolled. Anesthesia
was induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofol
administered and tracheal intubation performed. Baseline measurements of heart
rate, blood pressure, SpO2, peak inspiratory pressure (PIP), and
pulmonary compliance were made before casting,
immediately after casting, and after cast cut-out. Results: PIP increased from
15.8 cm H2O to 42.6 after cast application and decreased to 20.2
after cast cut-out. Compliance decreased from 1.08 ml/cm H2O/kg to
0.21 after cast application and increased to 0.61 after cast cut-out. There
were no clinically significant changes in heart rate, blood pressure, or SpO2.
Conclusion: The thoracolumbar cast applied for scoliosis treatment causes
severe restriction of chest wall movement and subsequent deterioration of
pulmonary function. The time of severe
restriction of chest wall motion is short and is relieved once cast cut-outs
are performed. The marked increase in PIP
and decrease in compliance that occurs during the casting process necessitates
tracheal intubation.