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Perioperative Anesthetic Management in Pediatric Scoliosis Surgery: A Narrative Review with Focus on Neuromuscular

Barbora Nedomová1, Boris Liščák2, Soňa Urbanová1

  • 1Department of Pediatric Anesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, 833 40 Bratislava, Slovakia.

Children (Basel, Switzerland)
|November 27, 2025
PubMed

Insights

Pediatric scoliosis surgery in patients with neuromuscular disorders poses risks. Evidence-based anesthetic management, including total intravenous anesthesia (TIVA) and Enhanced Recovery After Surgery (ERAS) protocols, is crucial for minimizing complications.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Neuromuscular Disorders

Background:

  • Pediatric scoliosis surgery, especially in patients with neuromuscular disorders, carries significant perioperative risks.
  • These risks include respiratory insufficiency, cardiovascular issues, and nutritional deficits.

Purpose of the Study:

  • To review evidence-based anesthetic management strategies for children with neuromuscular conditions undergoing scoliosis surgery.
  • To highlight key considerations for optimizing perioperative care in this high-risk population.

Main Methods:

  • Comprehensive literature review focusing on anesthetic techniques and multidisciplinary protocols.
  • Emphasis on intraoperative neurophysiological monitoring (IONM), blood conservation, and Enhanced Recovery After Surgery (ERAS) principles.

Main Results:

  • Individualized preoperative assessment is key.
  • Total intravenous anesthesia (TIVA) preserves IONM signal integrity.
  • Blood conservation (antifibrinolytics, cell salvage), normothermia, positioning, and multimodal analgesia are vital.
  • Postoperative care includes respiratory support and early mobilization via ERAS.

Conclusions:

  • Multidisciplinary, individualized anesthetic approach is essential for pediatric neuromuscular scoliosis surgery.
  • Adherence to TIVA, blood management, and ERAS protocols minimizes complications and improves outcomes.
Abstract

Keywords:
ERAS protocolblood conservationneuromuscular disorderspediatric anesthesiaperioperative managementscoliosistotal intravenous anesthesia

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