Anaesthesia for scoliosis surgery

Scoliosis can be classified into idiopathic, congenital, neuromuscular, or degenerative causes. Surgical intervention is required for severe curvatures, and symptomatic patients experiencing cardiorespiratory compromise or neurological deficit. Scoliosis surgery is mostly conducted in the prone position. Apart from prolonged surgical times, there is also a risk of major blood loss, hypothermia and significant postoperative pain. Total intravenous anaesthesia without muscle relaxation is the preferred anaesthetic agent to facilitate intraoperative neuromonitoring. Loss of neuromonitoring signal is a sensitive and specific indicator for spinal cord injury and needs to be addressed promptly. A wake-up test of motor function is the gold standard, but is not feasible in paediatric or uncooperative patients and is seldom required nowadays. Patients with neuromuscular scoliosis may have cardiorespiratory and neuromuscular comorbidities and are at increased risk for postoperative complications. Enhanced recovery after surgery is a multidisciplinary perioperative pathway that consists of pre-emptive and multimodal analgesia, intraoperative tranexamic acid, early mobilization, and nutritional and mental health assessment.