[Anesthetic problems and postoperative care in the surgery for scoliosis]

Scoliosis surgery in the adolescent is prolonged, painful and haemorrhagic. There are neurological risks and surveillance of the medulla is necessary throughout surgery. An anterior (Dwyer, Zielke) or posterior (Harrington, Cotrel-Dubousset, Luque) approach to the spinal column cas used. Surgery using a posterior approach is the more haemorrhagic. The haemorrhage is increased by poor positioning of the patient, by the duration of surgery and by taking the bone graft. Constant care should be given to blood economy, using controlled hypotension, haemodilution and peroperative autotransfusion of lost blood (Cell-Saver). The anaesthetic should provide excellent analgesic effects and must be compatible with regain of consciousness during surgery and/or or the use of evoked potential techniques. Complications at that time are those of the circulation and those of neurological origin and linked with hypothermia. In the presence of haemorrhage, the maintenance of total blood volume is difficult when there is cardiopathy (myopathy). Neurological complications should be detected sufficiently early for them to be reversible (sensori-motor evoked potentials and/or "wake-up test"). Hypothermia is constant and requires the systematic use of a heated mattress, a heated humidifier and the heating of infusions. The postoperative complications are respiratory in origin and are especially associated with neuro-muscular disease (postoperative artificial ventilation). The per- and postoperative difficulties demonstrate the importance of the preoperative examination and of the preparation of the operation (respiratory preparation). Finally, staged autotransfusion should be used, when possible, and should be part of the techniques of blood economy in a true transfusion strategy.