Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

Robin D.  Jensen; Andrew F.  Stasic; Shyam  Kishan; Eric  Scott; Deann M.  Martin; Stephen F.  Dierdorf

doi:10.4236/ojanes.2014.42005

Robin D. Jensen, Andrew F. Stasic, Shyam Kishan, Eric Scott, Deann M. Martin, Stephen F. Dierdorf^*

Abstract: Study Design: A prospective, observational case series of eighteen children with early onset scoliosis undergo spine manipulation and casting. Objective: Determine if respiratory system compliance decreases during casting warrants tracheal intubation in all Derotational casting procedures. Background: Children with early onset scoliosis with a Cobb angle greater than 25 degrees will have significant progression of their scoliosis. Surgical techniques cannot result in spine fusion as growth retardation will ensue. Serial thoracolumbar casting may correct the scoliosis or delay the need for surgery. The cast, however, is highly restrictive until the cast is appropriately cut. Does respiratory system compliance decrease a significant degree to require tracheal intubation in all Derotational casting procedures? Methods: Eighteen children (mean age: 4.5 years, mean weight: 16.9 kg) undergoing initial scoliosis casting were enrolled. Anesthesia was induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofol administered and tracheal intubation performed. Baseline measurements of heart rate, blood pressure, SpO2, peak inspiratory pressure (PIP), and pulmonary compliance were made before casting, immediately after casting, and after cast cut-out. Results: PIP increased from 15.8 cm H2O to 42.6 after cast application and decreased to 20.2 after cast cut-out. Compliance decreased from 1.08 ml/cm H2O/kg to 0.21 after cast application and increased to 0.61 after cast cut-out. There were no clinically significant changes in heart rate, blood pressure, or SpO2. Conclusion: The thoracolumbar cast applied for scoliosis treatment causes severe restriction of chest wall movement and subsequent deterioration of pulmonary function. The time of severe restriction of chest wall motion is short and is relieved once cast cut-outs are performed. The marked increase in PIP and decrease in compliance that occurs during the casting process necessitates tracheal intubation.

Keywords: Derotational Casting; Early Onset Scoliosis; Respiratory Compliance

Cite this paper: R. Jensen, A. Stasic, S. Kishan, E. Scott, D. Martin and S. Dierdorf, "Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis," Open Journal of Anesthesiology, Vol. 4 No. 2, 2014, pp. 36-40. doi: 10.4236/ojanes.2014.42005.

References

[1] T. Tsiligiannis and T. Grivas, “Pulmonary Function in Children with Idiopathic Scoliosis,” Scoliosis, Vol. 7, 2012, pp. 7-12. http://dx.doi.org/10.1186/1748-7161-7-7

[2] J. Donath and A. Miller, “Restrictive Chest Wall Disorders,” Seminars in Respiratory and Critical Care Medicine, Vol. 30, No. 3, 2009, pp. 275-292.
http://dx.doi.org/10.1055/s-0029-1222441

[3] P. Fernandes and S. L. Weinstein, “Natural History of Early Onset Scoliosis,” The Journal of Bone & Joint Surgery, Vol. 89, Suppl. 1, 2007, pp. 21-33.
http://dx.doi.org/10.2106/JBJS.F.00754

[4] L. A. Karol, “Early Definitive Spinal Fusion in Young Children,” Clinical Orthopaedics and Related Research, Vol. 469, No. 5, 2011, pp. 1323-1329.
http://dx.doi.org/10.1007/s11999-010-1622-z

[5] A. C. Koumbourlis, “Scoliosis and the Respiratory System,” Paediatric Respiratory Reviews, Vol. 7, No. 2, 2006, pp. 152-160.
http://dx.doi.org/10.1016/j.prrv.2006.04.009

[6] R. D. Labrom, “Growth and Maturation of the Spine from Birth to Adolescence,” The Journal of Bone & Joint Surgery, Vol. 89, Suppl. 1, 2007, pp. 3-7.

[7] M. T. Hresko, “Idiopathic Scoliosis in Adolescents,” The New England Journal of Medicine, Vol. 368, No. 9, 2013, pp. 834-841. http://dx.doi.org/10.1056/NEJMcp1209063

[8] K. Pehrsson, S. Larsson, A. Oden and A. Nachemson, “Long-Term Follow-Up of Patients with Untreated Scoliosis,” Spine, Vol. 17, No. 9, 1992, pp. 1091-1096.
http://dx.doi.org/10.1097/00007632-199209000-00014

[9] S. M. Swank, R. B. Winter and J. H. Moe, “Scoliosis and Cor Pulmonale,” Spine, Vol. 7, 1982, pp. 343-354.
http://dx.doi.org/10.1097/00007632-198207000-00004

[10] M. G. Vitale, J. A. Gomez, H. Matsumoto and D. P. Roye, “Variability of Expert Opinion in Treatment of Early-Onset Scoliosis,” Clinical Orthopaedics and Related Research, Vol. 469, No. 5, 2011, pp. 1317-1322.
http://dx.doi.org/10.1007/s11999-010-1540-0

[11] J. M. Flynn, H. Matsumoto, F. Torres, N. Ramirez and M. G. Vitale, “Psychologic Dysfunction in Children Who Require Repetitive Surgery for Early Onset Scoliosis,” Journal of Pediatric Orthopaedics, Vol. 32, No. 6, 2012, pp. 594-599.
http://dx.doi.org/10.1097/BPO.0b013e31826028ea

[12] G. J. Redding and O. Mayer, “Structure-Respiration Function Relationships before and after Surgical Treatment of Early-Onset Scoliosis,” Clinical Orthopaedics and Related Research, Vol. 469, No. 5, 2011, pp. 1330-1334.
http://dx.doi.org/10.1007/s11999-010-1621-0

[13] M. H. Mehta, “Growth as a Corrective Force in the Early Treatment of Progressive Infantile Scoliosis,” The Journal of Bone & Joint Surgery, Vol. 87, No. 9, 2005, pp. 1237-1247.
http://dx.doi.org/10.1302/0301-620X.87B9.16124

[14] J. O. Sanders, J. D’Astous, M. Fitzgerald, J. G. Khoury, S. Kishan and P. F. Sturm, “Derotational Casting for Progressive Infantile Scoliosis,” Journal of Pediatric Orthopaedics, Vol. 29, No. 6, 2009, pp. 581-587.
http://dx.doi.org/10.1097/BPO.0b013e3181b2f8df

[15] A. A. Dhawale, S. A. Shah, S. Reichard, L. Holmes, R. Brislin, K. Rogers and W. G. Mackenzie, “Casting for Infantile Scoliosis: The Pitfall of Increased Peak Inspiratory Pressure,” Journal of Pediatric Orthopaedics, Vol. 33, No. 1, 2013, pp. 63-67.
http://dx.doi.org/10.1097/BPO.0b013e318264936f

[16] A. Wald, D. Jason, T. W. Murphy and V. D. Mazzia, “A Computer System for Respiratory Parameters,” Computers and Biomedical Research, Vol. 2, No. 5, 1969, pp. 411-429.

[17] R. R. Uhl and F. J. Lewis, “Digital Computer Calculation of Human Pulmonary Mechanics Using a Least Squares Fit Technique,” Computers and Biomedical Research, Vol. 7, No. 5, 1974, pp. 489-495.

[18] C. A. Stahl, K. Moller, S. Schumann, R. Kuhlen, M. Sydow, C. Putensen and J. Guttman, “Dynamic versus Static Respiratory Mechanics in Acute Lung Injury and Acute Respiratory Distress Syndrome,” Critical Care Medicine, Vol. 34, No. 8, 2006, pp. 2090-2098.

[19] A. Larsson, C. Jonmarker, S. G. E. Lindahl and O. Werner, “Lung Function in the Supine and Lateral Decubitus Positions in Anaesthetized Infants and Children,” British Journal of Anaesthesia, Vol. 62, No. 4, 1989, pp. 378-384.

[20] M. Yazici and J. Emans, “Fusionless Instrumentation Systems for Congenital Scoliosis,” Spine, Vol. 34, 2009, pp. 1800-1807.

[21] J. E. Tis, L. I. Karlin, B. A. Akbarnia, L. C. Blakemore, G. H. Thompson, R. E. McCarthy, C. A. Tello, M. J. Mendelow and E. P. Southern, “Early Onset Scoliosis: Modern Treatment and Results,” Journal of Pediatric Orthopaedics, Vol. 32, No. 7, 2012, pp. 647-657.

[22] L. A. Karol, C. Johnston, K. Mladenov, P. Schochet, P. Walters and R. H. Browne, “Pulmpnary Function Following Early Thoracic Fusion in Non-Neuromuscular Scoliosis,” The Journal of Bone & Joint Surgery, Vol. 90, No. 6, 2008, pp. 1272-1281.

[23] D. M. Baulesh, J. Huh, T. Judkins, S. Garg, N. H. Miller and M. A. Erickson, “The Role of Serial Casting in Early-Onset Scoliosis (EOS),” Journal of Pediatric Orthopaedics, Vol. 32, No. 7, 2012, pp. 658-663.

[24] N. D. Fletcher, A. McClung, K. E. Rathjen, J. R. Denning, R. Browne and C. E. Johnston, “Serial Casting as a Delay Tactic in the Treatment of Moderate-to-Severe Early-Onset Scoliosis,” Journal of Pediatric Orthopaedics, Vol. 32, No. 7, 2012, pp. 664-671.

[25] E. K. Motoyama, V. F. Deeney, G. F. Fine, C. I. Yang, R. L. Mutich, S. A. Walczak and M. S. Moreland, “Effects on Lung Function of Multiple Expansion Thoracoplasty in Children with Thoracic Insufficiency Syndrome: A Longitudinal Study,” Spine, Vol. 31, 2006, pp. 284-290.

[26] E. K. Motoyama, C. I. Yang and V. F. Deeney, “Thoracic Malformation with Early-Onset Scoliosis: Effect of Serial VEPTR Expansion Thoracoplasty on Lung Growth and Function in Children,” Paediatric Respiratory Reviews, Vol. 10, No. 1, 2009, pp. 12-17.