What Parents Need to Know About Pediatric Anesthesia and Scoliosis Surgery

If your child is scheduled to undergo spine surgery for early onset scoliosis, adolescent idiopathic scoliosis or other spinal deformity, you’re likely overwhelmed with emotions and questions. Pediatric spine surgery can be complex and lengthy, and you want to ensure your child is surrounded by a team of experts. Your pediatric anesthesiologist is a key member of that team.

The thought of having your child “go under” during scoliosis surgery can evoke worry and concern. Is anesthesia safe for children? How do I know my child won’t have long-term problems because of anesthesia?

Anesthesia’s effect on children’s growing brain has been well researched, and there’s no definitive evidence suggesting it causes harm to children. But to explore this issue further, SpineUniverse reached out to Linda Mason, MD, a pediatric physician anesthesiologist and president-elect of the American Society of Anesthesiologists (ASA), for her thoughts on what parents need to know about pediatric anesthesia for scoliosis surgery.

Asian mother and young daughterPediatric spine surgery can be complex and lengthy, and you want to ensure your child is surrounded by a team of experts that includes a pediatric anesthesiologist. Photo Source: 123RF.com.

SpineUniverse: How is adult anesthesia different from that for a child or infant?
Dr. Mason: There are obvious size differences in adults versus children, but it’s more than that. There are many physiological differences as well—especially in kids under 3 years of age.

In young children, different areas of the body are developing at different times. Of particular importance is that the brain is still developing. For children under 3, we must be careful with how we use anesthesia to preserve healthy brain function and development.

Anesthesia requires different drug doses, monitoring, and knowledge of this physiology. At around 8 to 10 years of age, children become more like an adult in terms of organ function and way they manage anesthetic drugs.

SpineUniverse: When does the pediatric anesthesiologist join the child’s treatment team?
Dr. Mason:
When it comes to spine surgery for pediatric spinal deformity, a pediatric anesthesiologist should be involved from the very beginning. During the initial surgical discussions, the anesthesiologist needs to know how severe the scoliosis is and the surgical approach suggested to inform the anesthesia plan. This plan not only covers anesthesia during the spine surgery but the pain management used after surgery.

Discussing post-operative pain management with parents early in the process is so important. After surgery, we want children to wake up comfortable. We have many options for post-operative pain management for children, including non-steroidal anti-inflammatory drugs (eg, ibuprofen), acetaminophen (eg, Tylenol), and short-term opioids.

Many parents worry about the risks of opioids in children. The widely publicized opioid crisis has shown the negative—and in some cases, fatal—impact these drugs have had on adults who became addicted to them. With children, our goal is to limit opioid use to a very short period of time after surgery (typically less than a week) and use other modalities, such as Tylenol, ibuprofen, or regional anesthesia, to help children safely transition off opioids while still controlling pain.

SpineUniverse: In an urgent or emergency care situation, what should a parent/guardian ask the attending emergency physician to assure their child’s care?
Dr. Mason: Parents need to talk to the emergency department physician and the anesthesiologist about their care plan for their child. Good questions to ask include:

  • What kind of anesthesia will you use?
  • How long will the surgery take?
  • How will you manage my child’s pain after surgery?
  • What are the potential side effects of the anesthetic?

Parents also need to share the details of their child’s medical history (including current medications and any diagnoses) with any clinician involved in the child’s care, including the anesthesiologist. This will help the anesthesiologist tailor the child’s anesthesia to their medical needs.

SpineUniverse: Please share pediatric anesthesia risk factors and potential for complications specific to scoliosis.
Dr. Mason:
Children with spinal deformity can have varying degrees of pulmonary limitations—some are severe, some are mild. After surgery, it takes a while for the child’s pulmonary system to adjust now that the spine is straight.

To support pulmonary function after surgery, the anesthesiologist has the option of taking the breathing tube out after surgery or putting the child on a ventilator. How we make that decision depends largely on how limited the child’s respiratory function was before surgery.

Parents should know that, for some scoliosis surgeries, their child may need to have blood replaced. To minimize the risk for complications if blood needs to be replaced, parents can have their child (particularly if they are a teenager) donate blood before their surgery. That way, the surgeon has access to the child’s own blood if it’s needed during surgery.

Finally, the child will be in pain after surgery. To control post-operative pain, it’s best to leave the child on a ventilator for a few hours to ensure the child has controlled pain and is breathing well. Parents should have this discussion with the child’s anesthesiologist before surgery to avoid being alarmed if their child is still on a ventilator after surgery. The ventilator helps support breathing function while also controlling pain.

SpineUniverse: As part of the surgical team, what aspects of pre-, peri-, and post-operative care is the pediatric anesthesiologist involved?
Dr. Mason:
The pediatric anesthesiologist is involved in all 3 surgical phases—and all 3 phases hold equal importance.

During the pre-operative visit, the parents and child can have their questions answered by the anesthesiologist. The anesthesiologist can have his or her questions about the child’s medical history answered, too.

During the spine surgery, we are monitoring the child every minute of the procedure. We monitor blood pressure, heart rate, fluid (urine) output, and oxygen saturation in the blood. We administer fluids, anesthetic drugs for sleep, and we sometimes give blood.

After surgery, we are involved in the child’s respiratory system support and post-operative pain management.

SpineUniverse: What questions should a parent or guardian ask the pediatric anesthesiologist and/or surgeon before their child’s spine surgery?
Dr. Mason:
Parents should discuss these questions during a pre-operative visit with their child’s anesthesiologist:

  • What kind of monitoring devices will you use during surgery? Are these devices invasive?
  • Will my child need to have blood? If so, should my child donate blood to be used during surgery?
  • What kind of post-operative pain management will you recommend for my child? What are the potential side effects of those drugs?
  • Will my child have a breathing tube removed immediately after surgery, or will it need to stay in longer due to the severity of the scoliosis?
  • Are there regional anesthesia options available for my child (like an epidural injection)? Will these options make a difference for my child’s pain?

SpineUniverse: What steps can a parent or guardian take to ensure their child’s anesthesiologist is properly credentialed and in good standing?
Dr. Mason:
Parents can look up the qualifications of their pediatric anesthesiologist online. One way is to visit the treating facility’s website and searching for the name of the physician via the medical staff listing.

Another great resource for parents is The American Board of Anesthesiology search tool, which shows if an anesthesiologist is board certified.

SpineUniverse: What other anesthesia resources should parents explore before their child undergoes spine surgery?
Dr. Mason: The ASA has several resources to help both parents and kids get their questions about anesthesia answered before surgery. Parents should visit www.asahq.org/whensecondscount to connect to our full range of anesthesia information for parents and patients.

Updated on: 02/21/19
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