Description

This article addresses some of the issues that arise when planning and delivering anaesthesia for children requiring elective orthopaedic surgery. There are general principles of assessment and peri-operative management common to all types of procedure or underlying condition. Regional techniques can be very effective especially if local anaesthetics are combined with adjuncts such as fentanyl or clonidine. In operations where large blood loss is expected, autotransfusion can reduce the need for homologous transfusions. The specific anaesthetic implications of specific conditions are discussed. In severe cerebral palsy there may be developmental delay with difficulty communicating, chronic lung disease secondary to gastro-oesophageal reflux, and problems positioning contracted limbs. Children with spina bifida have a high incidence of latex allergy. A vital capacity of less than 30% in boys with Duchenne muscular dystrophy predicts serious post-operative complications after scoliosis surgery. Suxamethonium is absolutely  contraindicated in this population but the relationship between volatile agents and malignant hyperthermia is much less clear.