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Case Reports in Medicine
Volume 2009, Article ID 190263, 3 pages
http://dx.doi.org/10.1155/2009/190263
Case Report

Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion

Department of Anesthesiology, The Children's Hospital, University of Oklahoma Health Sciences Center, 750 North East 13th Street, Suite 200, Oklahoma City, OK 73104, USA

Received 20 July 2009; Accepted 11 September 2009

Academic Editor: Albert Dahan

Copyright © 2009 Mohanad Shukry et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA) which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs.