ANESTHETIC MANAGEMENT OF TWO ADOLESCENT GIRLS UNDERGOING POSTERIOR SPINAL FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS: TWO CASE REPORTS

Objective: To describe the perioperative anesthetic management of two adolescent girls undergoing posterior instrumented spinal fusion for adolescent idiopathic scoliosis (AIS), with emphasis on neurophysiological monitoring, blood conservation, and postoperative recovery.
Methods: Two girls aged 16 and 14 years (ASA physical status I) with progressive idiopathic thoracic scoliosis underwent posterior spinal fusion under general anesthesia. Propofol-based total intravenous anesthesia (TIVA) with fentanyl was used, together with arterial pressure monitoring, bispectral index monitoring, motor evoked potentials (MEPs), and somatosensory evoked potentials (SSEPs). Tranexamic acid was administered as part of a blood-conservation strategy.
Results: Operative times were 5 hours and 4 hours 30 minutes, with estimated blood losses of 650 mL and 500 mL, respectively; neither patient required transfusion. MEP and SSEP recordings remained stable, and both patients were extubated early without neurological or anesthetic complications. The postoperative courses were uneventful.
Conclusion: A coordinated strategy combining propofol-based TIVA, multimodal neurophysiological monitoring, blood-conservation measures, and multimodal analgesia may facilitate safe perioperative management of AIS surgery. As a two-case report, these observations cannot establish the causal effectiveness of any single component.