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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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IMPLEMENTATION OF PERIOPERATIVE SCOLIOSIS SURGERY PROTOCOL: IMPLICATIONS FOR THE ICU

Ana Margarida Ferreira1; Sónia Nóbrega1, Sofia Gouveia2,  Sara Ramos1

1 - Anestesiologia, Centro Hospitalar de Lisboa Central, EPE
2 - Imunohemoterapia, Centro Hospitalar de Lisboa Central, EPE

- Publicação sob a forma de apresentação oral no Congresso Internacional ESPNIC – European Society of Paediatric and Neonatal Intensive Care

Resumo:
Introdução: Scoliosis affects 2-4% of children. Scoliosis surgery aims to stop the progression of the disease, avoid worsening of respiratory and cardiac function, and improve quality of life and physical appearance.
Objetivos e MétodosWe developed a multidisciplinary protocol for standardizing care, aiming at minimizing blood transfusion requirements, optimizing pain control and reducing ICU stay. Retrospective analysis was performed comparing data before protocol development - 2012-2014 (n=21) and after protocol implementation - 2016 (n=28). The protocol introduced standard pre-operative evaluation and optimization and intraoperative management:
Resultados: There were no statistical differences between groups regarding gender, age and scoliosis etiology. Pre and post-operatory haemoglobin was improved and transfusional requirements were reduced. Pain scores on the epidural group were statistically lower at immediate post-operative, 24 and 48 hours after surgery (p<0.05). ICU length of stay was shorter with epidural analgesia (p<0.001).
ConclusõesWe obtained a substantial reduction in transfusional requirements with perioperative protocol optimization. Epidural analgesia is effective in paediatric scoliosis surgery with significant reduction of pain scores, with no complications. With the perioperative scoliosis surgery protocol transfusional requirements and post-operative analgesia were optimized and a significant reduction in ICU length of stay was observed.

Palavras Chave: Scoliosis surgery; protocol