Severe hypotension and hepatic dysfunction in a patient undergoing scoliosis surgery in the prone position

Many patients with neuromuscular disorders develop progressive scoliosis and require corrective surgery. We present a patient with hereditary motor and sensory neuropathies who developed severe hypotension during corrective surgery for thoracolumbar scoliosis. The haemodynamic disturbance was probably secondary to thoracic hyperlordosis and the knee-chest position and was aggravated by surgical manipulation. This may beprevented by tailored preoperative evaluation of different patient prone position supports and frames in order to select that which causes least cardiovascular and respiratory disturbance. This patient also developed severely deranged liver function postoperatively and the possible aetiology is discussed.link_to_subscribed_fulltex

Pediatric Sedation: The Asian Approach - Current State of Sedation in China

In China, the need for sedation and analgesia for both diagnostic and therapeutic procedures performed outside the operating room has increased dramatically in recent years. In China there are currently no national guidelines on providing sedation to either children or adults. Hong Kong, although a Special Administrative Region of the Peoples Republic of China (PRC), has its own independent Academy of Medicine, which does issue guidelines. For the purpose of this chapter, the authors will consider Hong Kong as separate from China, since currently the two regions approach sedation in a vastly different manner. In order to understand the current state of pediatric sedation, a survey was sent to 41 hospitals, all members of the Pediatric Anesthesia Association in China. The size of hospitals ranged from 500 to 4,200 beds and the number of pediatric operations performed in these hospitals ranged from 3,000 to 60,000 in 2012. The response rate was 53.6 %. Of the 22 completed surveys, five hospitals responded that they had no sedation service (their surveys were not returned) and two indicated that anesthesiologists are not involved in their sedation services