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Perioperative Care in Paediatric Orthopaedic Surgery

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Perioperative Medicine in Pediatric Anesthesia

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Abstract

The orthopaedic paediatric patient includes all stages of development, from birth to adolescence, and ranges from a normal healthy child to a child with multiple congenital malformations, neuromuscular diseases or metabolic disorders and may be a challenge for the anaesthetist. Anaesthetic services are also commonly required for sedation during diagnostic procedures, non-invasive treatment of fractures and other short but painful procedures. Several of these procedures may be suitable for day surgery as well.

The two major categories of orthopaedic surgery include peripheral paediatric orthopaedic surgery, which includes any surgery on muscles, tendons, bones or joints of children’s upper and lower limbs, and spine surgery, especially for scoliosis. Perioperative problems in those surgeries may be intraoperative positioning, intraoperative warming, application of tourniquet, incidence of fat embolism, compartment syndrome or the need for thromboprophylaxis. Paediatric patients undergoing major orthopaedic surgery are at risk of significant intraoperative blood loss, and optimised blood management is mandatory and includes consideration of preoperative autologous blood donation, intraoperative blood recovery and reinfusion, use of antifibrinolytics and application of correct transfusion trigger.

Another challenge in orthopaedic surgery is pain treatment for intense perioperative pain. An adequate multimodal pain therapy concept must be implemented with local or regional anaesthesia whenever possible. Intense, long-term postoperative pain may require continuous peripheral nerve blockade with catheter, which is a valuable alternative to parenteral opioids or continuous neuraxial blockade. General anaesthesia supplemented with pre-emptive regional anaesthesia produces better operating conditions and reduced risks of surgical blood loss in children, and this may contribute to shorter operating time. Supraglottic devices are widely used for securing and maintaining a patent airway in orthopaedic surgery as an alternative to tracheal intubation in patients requiring general anaesthesia or very deep sedation and help to control the not uncommon difficult airway in the orthopaedic paediatric patient not requiring muscle relaxation.

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Authors and Affiliations

  1. Istituto di Anestesia e Rianimazione, Azienda Ospedaliera Università, Padova, Italy

    A. U. Behr

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  1. A. U. Behr
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Correspondence to A. U. Behr .

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Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, AO-U Policlinico di Catania, Catania, Italy

    Marinella Astuto

  2. MUHC Montreal Children’s Hosp, McGill Un, Department of Anesthesia, Montreal, Canada

    Pablo M Ingelmo

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Behr, A.U. (2016). Perioperative Care in Paediatric Orthopaedic Surgery. In: Astuto, M., Ingelmo, P. (eds) Perioperative Medicine in Pediatric Anesthesia. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-21960-8_7

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  • DOI: https://doi.org/10.1007/978-3-319-21960-8_7

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21959-2

  • Online ISBN: 978-3-319-21960-8

  • eBook Packages: MedicineMedicine (R0)

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