Anesthetic and Post-operative Pain Management
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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.
KeywordsOsteogenesis imperfecta Anesthesia Pain management Neuraxial anesthesia Peripheral nerve blockade Blood loss management
- 3.Standards for Basic Anesthetic Monitoring. Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, last amended on October 20, 2010, and last affirmed on October 28, 2016). https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf
- 10.Goobie SM, Cladis FP, Glover CD, Huang H, Reddy SK, Fernandez AM, Zurakowski D, Stricker PA, Gries; the Pediatric Craniofacial Collaborative Group. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Paediatr Anaesth. 2017;27(3):271–81.CrossRefGoogle Scholar
- 11.Goobie SM, Zurakowski D, Glotzbecker MP, McCann ME, Hedequist D, Brustowicz RM, Sethna NF, Karlin LI, Emans JB, Hresko MT. Tranexamic acid is efficacious at decreasing the rate of blood loss in adolescent scoliosis surgery: a randomized placebo-controlled trial. J Bone Joint Surg Am. 2018;100(23):2024–32.CrossRefGoogle Scholar