Bradycardia and hypotension during pediatric scoliosis surgery-hypovolemia or spinal shock?

摘要

We present the case of a 13-year-old boy undergoing scoliosis repair utilizing skull-femoral traction who developed sudden, sustained bradycardia and hypotension during scoliosis repair, associated with loss of somatosensory evoked potentials and motor evoked potentials to all four limbs. A diagnosis of spinal shock and hypovolemia was made after ruling out primary cardiac causes, sepsis, anaphylaxis and intra-spinal pedicle screw placement. Acute complications of surgical scoliosis repair are reviewed along with anatomy of the sympathetic nervous system. In this case spinal shock may have been due to hypovolemia as well as spinal cord manipulation during T12 vertebral column resection that was needed to effect scoliosis correction. Treatment included volume expansion and inotropic support. Anesthesiologists caring for these patients should be mindful of the possibility of spinal shock during correction of severe scoliosis, particularly when vertebral column resection is undertaken.