Posterior Spinal Fusion

Posterior Spinal Fusion

• Patients are usually teenagers with scoliosis.
• IV or inhalational induction
• Small dose of muscle relaxant is appropriate to facilitate intubation
• 2 large bore peripheral intravenous lines and arterial catheter
• Neuromonitoring employed--usually MEPs, SSEPs
• General anesthesia generally included with 0.5 MAC volatile agent and infusions of propofol, fentanyl. Consider a transexamic acid infusion (10-50 mcg/kg bolus over 15 min, follwed by 1-5 mcg/kg/hr)
• Well-placed bite block to protect oral contents during MEPs
• Typed/cross-matched blood/components available for transfusion
• The surgeon often requests deliberate hypotension (MAP<60); this occasionally requires IV boluses of nitroglycerine 25-100mcg.
• The surgeon will often either place Deopdur, 10 mg in the epidural space, or place an epidural catheter under direct visualization. In both cases, the pain service must be notified. Only dilaudid should be given via the epidural catheter. The pain service can assist with appropriate epidural orders.
• Awake extubation or post operative ventilator support (rare). In most cases, patients typically are transported directly from the operating room to the PICU.