Adolescent Idiopathic Scoliosis

When I was on my medical mission trip to Guatemala several months ago, we had a case of a young teenager with adolescent idiopathic scoliosis who underwent a large multilevel spine surgery. We managed to safely and effectively complete the case despite not having our usual resources. Our anesthetic choices were limited, we didn't have arterial pressure monitoring, we didn't have intraoperative neurologic monitoring, and we didn't even have the right bed for the patient. But at the end of the day, the procedure was a success and the patient was thrilled.

My first day back on pediatrics, I was assigned to a similar scoliosis surgery. In fact, we had the same surgeon and team. But here at Lucille Packard, I had the luxury of remifentanil, arterial pressure monitoring, neuromonitoring with a technician and neurologist, prone bed, multiple IVs, multimodal pain therapies with a pain team that would follow the patient, blood products, and backup if we needed help. It was so incredibly different. The patient also did very well, and may have had a smoother post-operative course with our pain management resources here.

In the United States and at hospitals like Stanford, we have a luxury of resources. We get used to having everything, to utilizing state-of-the-art cutting-edge technologies, to relying on a multidisciplinary team of health professionals. This leads to remarkable care. But there are places, times, and circumstances where we may not have such a wealth of stuff. When I compare the anesthetic for the two scoliosis cases, I really think both methods can be done safely and effectively. The key for the case with limited resources was thorough pre-planning, an understanding of what I had available, and a flexibility to make it work.