Abstract
Scoliosis correction surgery in pediatric patients poses complex anesthetic challenges due to significant anatomical deformities, cardiopulmonary compromise, and the potential for substantial blood loss. Patients frequently exhibit significant cardiopulmonary compromise due to severe thoracic curvature and rib cage distortion, which impairs pulmonary gas exchange and increases the likelihood of perioperative complications. The severity of Cobb's angle, the number of affected vertebrae, and coexisting syndromes like kyphoscoliosis influence these cardiopulmonary changes and can lead to abnormalities in the airway, craniofacial skeleton, neurological system, and genitourinary tract. Comprehensive perioperative management requires meticulous preoperative optimization, intraoperative vigilance, and multidisciplinary coordination. Preoperative evaluation focuses on assessing respiratory function, cardiovascular adaptation, and identification of any associated syndromes that influence airway management and anesthetic planning. Intraoperatively, securing the airway despite distorted anatomy is critical; invasive monitoring, deliberate hypotension, and strategies to maintain normothermia are key adjuncts. Neuromonitoring, particularly somatosensory and motor evoked potentials, mandates careful anesthetic titration to preserve signal integrity while ensuring adequate analgesia and immobility. Blood conservation strategies including antifibrinolytics, cell salvage, and hemodilution are critical to minimize transfusion requirements. Postoperative care has evolved significantly with adoption of Enhanced Recovery After Surgery (ERAS) protocols, tailored to pediatric populations undergoing extensive spinal correction. Postoperative concerns encompass respiratory failure, pain control through multimodal analgesia, and vigilance for neurological or hemodynamic deterioration. Employing regional techniques such as erector spinae plane blocks with opioid-sparing multimodal regimen helps ensure effective analgesia, reduce opioid-related side effects, and promote early mobilization, which is crucial for minimizing postoperative pulmonary complications and accelerating functional recovery. An individualized, evidence-based anesthetic plan integrating optimized physiology, real-time neuromonitoring, and multidisciplinary collaboration is essential for improving safety and outcomes in pediatric scoliosis surgery. Emerging modalities, such as AI-assisted anesthesia and closed-loop systems show considerable promise for enhancing real-time monitoring, anticipating complications, and personalizing anesthetic delivery, thereby reducing human error and improving acre quality.