A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative

Laura E Gilbertson; Wallis T Muhly; Michael C Montana; Vidya Chidambaran; Sabina DiCindio; Kesavan Sadacharam; Robert T Wilder; Simon D Whyte; Alan Hifko; Paul D Sponseller; David D Frankville; North American Pediatric Spine Anesthesiologists Investigators

doi:10.1111/pan.14895

A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative

Paediatr Anaesth. 2024 Apr 5. doi: 10.1111/pan.14895. Online ahead of print.

Collaborators

North American Pediatric Spine Anesthesiologists Investigators:
Christopher Allphin, Annie Amin, Thomas M Austin, Aimee Bejar, Alan R Bielsky, Bruce R Brenn, Myles Cassidy, Sabeena Chacko, Yvonne Csanyi-Fritz, Anushree Doshi, Tiffany Frazee, Jonathan S Gal, Eliot Grigg, Dawit T Haile, Jennie Hamrick, Kathryn Handlogten, Cassandra Hoffmann, Joann Hunsberger, Aruna Kamath, Riva Ko, Ashley Lefevre, Lisa R Lynch, Jose Luis Martinez, Mary E McCann, Jason Mishal, Robert Moore, Thanh Nguyen, Dolores B Njoku, Bukola Ojo, Michale Ok, Teeda Pinyavat, Ronak Patel, Kristen Spisak, Chis J Stemland, Casey Stondell, Rani Sunder, Sundeep Tumber, Francoise Yung

Affiliations

¹ Department of Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA.
² Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
⁴ Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Department of Anesthesiology, Nemours Children's Hospital, Wilmington, Delaware, USA.
⁶ Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
⁷ Department of Anesthesiology, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁸ Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Anesthesia Services Medical Group, Rady Children's Hospital of San Diego, San Diego, California, USA.

PMID: 38578166
DOI: 10.1111/pan.14895

Abstract

Background: Adolescent Idiopathic Scoliosis (AIS) affects 2%-4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management.

Aims: To examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon.

Methods: A web-based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital.

Results: Thirty-one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7-93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3-89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3-100) and an arterial line (100%; 95% CI 88.8-100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6-99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7-93.3).

Conclusion: Most anesthesiologists (87.1%; 95% CI 80.6-99.9) report the use of some form of an anesthesia-based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.

Keywords: adolescent; general anesthesia; scoliosis; spine.