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Anesthetic and Post-operative Pain Management

  • Jessica K. GoellerEmail author
  • Leelach Rothschild
Chapter

Abstract

Patients with osteogenesis imperfecta, especially the moderate to severe types, require frequent surgical intervention. Anesthetic management and post-operative pain management benefit from careful preparation and a multimodal analgesic approach. Perioperative challenges that are of primary concern for anesthesiologists include airway challenges, intravenous catheter placement challenges, neuraxial and regional anesthesia placement difficulty, and significant intraoperative blood loss. Historical concern for malignant hyperthermia has been refuted and will not be discussed. Airway management may be difficult because of facial dysmorphism, macroglossia, megalocephaly, cervical instability, a short neck, and thoracic kyphoscoliosis with pectus carinatum. These skeletal abnormalities, along with frequent fractures, lead to bony protrusions and irregular bony landmarks that may make neuraxial and regional anesthesia more challenging. An additional perioperative concern is the potential for osteogenesis imperfecta patients to sustain additional fractures while undergoing surgery and anesthesia. Careful planning is required to successfully manage OI patients and the anesthetic challenges they pose and avoid complications in these fragile patients.

Keywords

Osteogenesis imperfecta Anesthesia Pain management Neuraxial anesthesia Peripheral nerve blockade Blood loss management 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Division of Pediatric AnesthesiologyChildren’s Hospital & Medical CenterOmahaUSA
  3. 3.Department of AnesthesiologyShriners Hospitals for ChildrenChicagoUSA
  4. 4.Department of AnesthesiologyUniversity of Illinois Hospital and Health Sciences SystemChicagoUSA

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