PEDIATRIC ORTHOPEDIC ANESTHESIA PRACTICE
A subset of pediatric patients may have to undergo repeated hospitalization
and orthopedic surgical procedures (see Chapter
45
and Chapter 60
).
These patients include children with cerebral palsy, congenital spine deformities,
juvenile rheumatoid arthritis, osteogenesis imperfecta, epiphyseal dysplasia, and
various forms of scoliosis. Many of these patients suffer from pain, disability,
and social isolation. They therefore deserve additional care
and sympathy along with excellence of clinical practice to overcome sometimes formidable
technical difficulties.
Cerebral Palsy
Children with cerebral palsy may present technical difficulties
because of contractures that make intraoperative positioning difficult. Many of
these children were born prematurely and suffer the residua of bronchopleural dysplasia
with tracheomalacia, irritable airways, and residual lung dysfunction. They may
develop recurrent aspiration due to gastroesophageal reflux. Hypothalamic dysfunction
may be a component of the cerebral palsy, making perioperative hypothermia more likely.
The tracheas of patients with certain congenital deformities of
the spine may be difficult to intubate for technical reasons (see Table
61-1
). Fiberoptic laryngoscopy (with pediatric equipment) or regional
anesthesia may be necessary. Generalized ligamentous laxity of the cervical spine
and atlantoaxial subluxation or stenosis of the foramen magnum may predispose these
patients to spinal cord compression with the potential for quadriparesis during anesthesia.
