Anesthesia and severe idiopathic scoliosis correction in Jehova witness patients. Case report and review
Keywords:
Scoliosis, Blood transfusion, Hemodilution, Erythropoietin
Abstract
Scoliosis is a complex, three-dimensional rotational deformity that involves the column in a sagittal, coronal and axial planes. It may be congenital, neuromuscular or idiopathic. The main symptom in 90% of cases is back pain, and initial management is fairly conservative. However, it may be severe enough as to cause other symptoms, neurologic deficit or necessity of surgical intervention. In such cases, surgery implies a great risk because of the complications that have been reported, including severe bleeding and nervous injury. Rigorous preoperative assessment is mandatory, as well as intraoperative planning aimed at complication risk reduction. Patients may also have comorbidities that increase risks or religious beliefs that forbid blood component transfusions, further complicating patient management.
The present article is a revision of scientific literature on major column surgery in Jehova witness patients, emphasizing blood optimization techniques. This research was carried out because of a case of severe idiopathic scoliosis with severe pulmonary compromise in the past year and functional class detriment in a Jehova witness. The patient underwent corrective surgery at Clínica CES in the city of Medellín (Colombia), which achieved a positive clinical outcome with no blood component transfusion.
References
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15. Minahan RE, Sepkuty JP, Lesser RP, Sponseller PD, Kostuik JP. Anterior spinal cord injury with preserved neurogenic 'motor' evoked potentials. Clin Neurophysiol. 2001;112:1442-50.
16. Pajewski TN, Arlet V, Phillips LH. Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur Spine J. 2007;16:115-29.
17. Browning JL, Heizer ML, Baskin DS. Variations in corticomotor and somatosensory evoked potentials: effects of temperature, halothane anesthesia, and arterial partial pressure of CO2. Anesth Analg. 1992;74:643-8.
18. Sloan T, Rogers J. Dose and timing effect of etomidate on motor evoked potentials elicited by transcranial electric or magnetic stimulation in monkey and baboon. J Clin Monit Comput. 2009;23:253-61.
19. Scheufler KM, Zentner J. Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J Neurosurg. 2002;96:571-9.
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21. Sloan TD, Janik D, Jameson L. Multimodality monitoring of the central nervous system using motor-evoked potentials. Curr Opin Anaesthesiol. 2008;21:560-4.
22. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2007:4.
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29. Lo KS, Chow BF, Chan HT, Gunawardene S, Luk KD. An autologous blood donation program for paediatric scoliosis patients in Hong Kong. Anaesth Intensive Care. 2002;30:775-81.
30. Brookfield KF, Brown MD, Henriques SM, Buttacavoli FA, Seitz AP. Allogeneic transfusion after pre-donation of blood for elective spine surgery. Clin Orthop Relat Res. 2008;466:1949-53.
31. Du Toit G, Relton JE, Gillespie R. Acute haemodilutional autotransfusion in the surgical management of scoliosis. J Bone Joint Surg Br. 1978;60:178-80.
32. Tse EY, Cheung WY, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
33. Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, et al. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227-31.
34. Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, et al. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227-30.
35. Oriani G, Pavesi M, Oriani A, Bollina I. Acute normovolemic hemodilution. Transfus Apher Sci. 2011;45:269-74.
36. Epstein NE. Bloodless spinal surgery: a review of the normovolemic hemodilution technique. Surg Neurol. 2008;70:614-8.
37. Hïebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-17.
38. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36:2667-74.
39. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198-208.
40. Vitale MG, Privitera DM, Matsumoto H, Gomez JA, Waters LM, Hyman JE, et al. Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine. 2007;32:2662-7.
41. Ball AM, Winstead PS. Recombinant human erythropoietin therapy in critically ill Jehovah's witnesses. Pharmacotherapy. 2008;28:1383-90.
42. Belfort M, Kofford S, Varner M. Massive obstetric hemorrhage in a Jehovah's witness: intraoperative strategies and high-dose erythropoietin use. Am J Perinatol. 2011;28:207-10.
43. Crescenzi G, Landoni G, Biondi-Zoccai G, Pappalardo F, Nuzzi M, Bignami E, et al. Desmopressin reduces transfusion needs after surgery. A meta-analysis of randomized clinical trials. Anesthesiology. 2008;109:1063-75.
44. Schouten ES, van de Pol AC, Schouten AN, Turner NM, Jansen NJ, Bollen CW. The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis. Pediatr Crit Care Med. 2009;10:182-90.
45. Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2008;3:6883.
46. Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am. 2008;90:2399-407.
47. Levy JH. Safety of aprotinin in heparinized and non-heparinized patients. J Cardiothorac Vasc Anesth. 2004;18:38-42.
48. Grant JA, Howard J, Luntley J, Harder J, Aleissa S, Parsons D. Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid. J Pediatr Orthop. 2009;29:300-4.
49. Sachs B, Delacy D, Green J, Graham RS, Ramsay J, Kreisler N, et al. Recombinant activated factor VII in spinal surgery: a multicenter, randomized, double-blind, placebo-controlled, dose-escalation trial. Spine. 2007;32:2285-93.
50. Williams EL. Postoperative blindness. Anesthesiol Clin North America. 2002;20:605-22.
51. Lee LA, Newman NJ, Wagner TA, Dettori JR, Dettori NJ. Postoperative ischemic optic neuropathy. Spine. 2010;35:105-16.
52. Tse EY, Cheung WI, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
53. Gause PR, Siska PA, Westrick ER, Zavatsky J, Irrgang JJ, Kang JD. Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients. Spine. 2008;33:571-5.
54. Behrman MJ, Keim HA. Perioperative red blood cell salvage in spine surgery. A prospective analysis. Clin Orthop Relat Res. 1992;278:51-7.
55. Samudrala S. Topical hemostatic agents in surgery: a surgeon's perspective. AORN J. 2008;88:2-11.
56. Joseph SA, Berekashvili K, Mariller MM, Rivlin M, Sharma K, Casden A, et al. Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion. Spine. 2008;33:2310-5.
57. Khine HH, Naidu R, Cowell H, MacEwen GD. A method of blood conservation in Jehovah's witnesses: incirculation diversion and reinfusion. Anesth Analg. 1978;57: 279-80.
58. Vitale M, Privitera DM, Matsumoto H, Gomez JA, Waters LM, Hyman JE, et al. Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine. 2007;32:2662-7.
2. Brines JK, White AP, Albert TJ, Shaffrey CI, Harrop JS. Adult degenerative scoliosis: a review. Neurosurgery. 2008;63:94-103.
3. Winter RB, Lonstein JE, Denis F. Pain patterns in adult scoliosis. Orthop Clin North Am. 1988;19:339-45.
4. Aebi M. The adult scoliosis. Eur Spine J. 2005;14:925-48.
5. Elgafy H, Bransford RJ, Maguire RA, Dettori JR, Fischer D. Blood loss in major spine surgery. Are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine. 2010;35:47-56.
6. Baron EM, Albert TJ. Medical complications of surgical treatment of adult spinal deformity and how to avoid them. Spine. 2006;31:106-18.
7. Freeman BL. Scoliosis and kyphosis. En: Canale TS, editor. Campbell's Operative Orthopedics. 9th ed. St. Louis: Mosby-Year Book/Mosby; 2002. p. 2849-3014.
8. Grossfeld S, Winter RB, Lonstein JE, Denis F, Leonard A, Johnson L. Complications of anterior spinal surgery in children. J Pediatr Orthop. 1997;17:89-95.
9. McDonnell MF, Glassman SD, Dimar 2nd JR, Puno RM, Johnson JR. Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am. 1996;78:839-47.
10. Goldenberg NA, Jacobson L, Manco-Johnson MJ. Brief communication: duration of platelet dysfunction after a 7-day course of ibuprofen. Ann Intern Med. 2005;142:506-9.
11. Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res. 1973;93:173.
12. Dawson EG, Sherman JE, Kanim LE, Nuwer MR. Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine. 1991;16:361-4.
13. Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. 1995;96:6-11.
14. Hilibrand AS, Schwartz DM, Sethuraman V, Vaccaro AR, Albert TJ. Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am. 2004;86:1248-53.
15. Minahan RE, Sepkuty JP, Lesser RP, Sponseller PD, Kostuik JP. Anterior spinal cord injury with preserved neurogenic 'motor' evoked potentials. Clin Neurophysiol. 2001;112:1442-50.
16. Pajewski TN, Arlet V, Phillips LH. Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur Spine J. 2007;16:115-29.
17. Browning JL, Heizer ML, Baskin DS. Variations in corticomotor and somatosensory evoked potentials: effects of temperature, halothane anesthesia, and arterial partial pressure of CO2. Anesth Analg. 1992;74:643-8.
18. Sloan T, Rogers J. Dose and timing effect of etomidate on motor evoked potentials elicited by transcranial electric or magnetic stimulation in monkey and baboon. J Clin Monit Comput. 2009;23:253-61.
19. Scheufler KM, Zentner J. Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J Neurosurg. 2002;96:571-9.
20. Fehlings MG, Brodke DS, Norvell DS, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery. Does it make a difference? Spine. 2010;35:37-46.
21. Sloan TD, Janik D, Jameson L. Multimodality monitoring of the central nervous system using motor-evoked potentials. Curr Opin Anaesthesiol. 2008;21:560-4.
22. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2007:4.
23. Cha CW, Deible C, Muzzonigro T, Lopez-Plaza I, Vogt M, Kang JD. Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine. 2002;27:99-104.
24. Menovsky T, De Ridder D. Simple intraoperative technique for hemostasis of cervical venous bleeding. Neurosurgery. 2008;62:442-4.
25. Park CK. The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery. Anesth Analg. 2000;91:552-7.
26. Bostman O, Hyrkas J, Hirvensalo E, Kallio E. Blood loss, operating time, and positioning of the patient in lumbar disc surgery. Spine. 1990;15:360-3.
27. Guest JD, Vanni S, Silbert L. Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J. 2004;4:130-7.
28. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71-7.
29. Lo KS, Chow BF, Chan HT, Gunawardene S, Luk KD. An autologous blood donation program for paediatric scoliosis patients in Hong Kong. Anaesth Intensive Care. 2002;30:775-81.
30. Brookfield KF, Brown MD, Henriques SM, Buttacavoli FA, Seitz AP. Allogeneic transfusion after pre-donation of blood for elective spine surgery. Clin Orthop Relat Res. 2008;466:1949-53.
31. Du Toit G, Relton JE, Gillespie R. Acute haemodilutional autotransfusion in the surgical management of scoliosis. J Bone Joint Surg Br. 1978;60:178-80.
32. Tse EY, Cheung WY, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
33. Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, et al. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227-31.
34. Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, et al. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227-30.
35. Oriani G, Pavesi M, Oriani A, Bollina I. Acute normovolemic hemodilution. Transfus Apher Sci. 2011;45:269-74.
36. Epstein NE. Bloodless spinal surgery: a review of the normovolemic hemodilution technique. Surg Neurol. 2008;70:614-8.
37. Hïebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-17.
38. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36:2667-74.
39. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198-208.
40. Vitale MG, Privitera DM, Matsumoto H, Gomez JA, Waters LM, Hyman JE, et al. Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine. 2007;32:2662-7.
41. Ball AM, Winstead PS. Recombinant human erythropoietin therapy in critically ill Jehovah's witnesses. Pharmacotherapy. 2008;28:1383-90.
42. Belfort M, Kofford S, Varner M. Massive obstetric hemorrhage in a Jehovah's witness: intraoperative strategies and high-dose erythropoietin use. Am J Perinatol. 2011;28:207-10.
43. Crescenzi G, Landoni G, Biondi-Zoccai G, Pappalardo F, Nuzzi M, Bignami E, et al. Desmopressin reduces transfusion needs after surgery. A meta-analysis of randomized clinical trials. Anesthesiology. 2008;109:1063-75.
44. Schouten ES, van de Pol AC, Schouten AN, Turner NM, Jansen NJ, Bollen CW. The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis. Pediatr Crit Care Med. 2009;10:182-90.
45. Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2008;3:6883.
46. Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am. 2008;90:2399-407.
47. Levy JH. Safety of aprotinin in heparinized and non-heparinized patients. J Cardiothorac Vasc Anesth. 2004;18:38-42.
48. Grant JA, Howard J, Luntley J, Harder J, Aleissa S, Parsons D. Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid. J Pediatr Orthop. 2009;29:300-4.
49. Sachs B, Delacy D, Green J, Graham RS, Ramsay J, Kreisler N, et al. Recombinant activated factor VII in spinal surgery: a multicenter, randomized, double-blind, placebo-controlled, dose-escalation trial. Spine. 2007;32:2285-93.
50. Williams EL. Postoperative blindness. Anesthesiol Clin North America. 2002;20:605-22.
51. Lee LA, Newman NJ, Wagner TA, Dettori JR, Dettori NJ. Postoperative ischemic optic neuropathy. Spine. 2010;35:105-16.
52. Tse EY, Cheung WI, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
53. Gause PR, Siska PA, Westrick ER, Zavatsky J, Irrgang JJ, Kang JD. Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients. Spine. 2008;33:571-5.
54. Behrman MJ, Keim HA. Perioperative red blood cell salvage in spine surgery. A prospective analysis. Clin Orthop Relat Res. 1992;278:51-7.
55. Samudrala S. Topical hemostatic agents in surgery: a surgeon's perspective. AORN J. 2008;88:2-11.
56. Joseph SA, Berekashvili K, Mariller MM, Rivlin M, Sharma K, Casden A, et al. Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion. Spine. 2008;33:2310-5.
57. Khine HH, Naidu R, Cowell H, MacEwen GD. A method of blood conservation in Jehovah's witnesses: incirculation diversion and reinfusion. Anesth Analg. 1978;57: 279-80.
58. Vitale M, Privitera DM, Matsumoto H, Gomez JA, Waters LM, Hyman JE, et al. Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine. 2007;32:2662-7.
How to Cite
1.
Rivera Diaz RC, Londoño W, González Obregón MP, Cifuentes Hoyos V. Anesthesia and severe idiopathic scoliosis correction in Jehova witness patients. Case report and review. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Apr. 19];40(4):323–331. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/853
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2012-10-01
How to Cite
1.
Rivera Diaz RC, Londoño W, González Obregón MP, Cifuentes Hoyos V. Anesthesia and severe idiopathic scoliosis correction in Jehova witness patients. Case report and review. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Apr. 19];40(4):323–331. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/853
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Case Report / Case Series
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