A Multi-Centre Multi-National Survey of Anaesthetists Regarding the Range of Anaesthetic and Surgical Practices for Paediatric Scoliosis Surgery

Abstract

Institutional responses to a detailed multi-national survey were used to characterise the range of current anaesthetic and surgical practices for paediatric scoliosis surgery. Questions addressed surgical practice, anaesthetic agents, blood-sparing techniques, neurophysiological monitoring used and recalled major complications. Twenty-seven (87%) institutions responded. The median number of cases of these institutions was 40 per year (range 5 to 700). Common practices included inhaled volatile anaesthetic maintenance (80%), omission of nitrous oxide (81%), intravenous remifentanil (88% [range 0.05 to 2.00 μg.kg-1.min-1]), and double intravenous antiemetic agent prophylaxis (59%); multimodal analgesia with paracetamol and parenteral opioids, non-steroidal anti-inflammartory drugs and epidural local anaesthetic or opioid infusion (UK) and intrathecal opioids and sub-anaesthetic doses of intravenous ketamine by infusion (Australia); use of cell-saver (81%), controlled hypotension (77%) and antifibrinolytic agents (74%) (intravenous aprotinin [59%] or tranexamic acid [44%]); and epidural somatosensory (92%), neurogenic motor-evoked (32%), compound motor action (31%) and transcranial motor-evoked potential monitoring (54%), with routine wake-up test used infrequently (19%). Fifty-four neurological or cardiac adverse events or deaths were recalled. While institutional practices varied, common themes were identified. The information obtained may suggest new strategies to various centres and could be useful for planning multi-centre audits and trials.