Refractory Hypotension Caused By Prone Position in a Child Undergoing Scoliosis Corrective Surgery

We report a case of a teenager with scoliosis and pectus excavatum who developed intraoperative refractory hypotension associated with prone position during posterior surgical correction of scoliosis. In this case, it was more difficult for the anesthetists to figure out the reason leading to severe hypotension when a surgery was partially completed, because there might be many confounding factors during surgery. Furthermore, TEE was difficult to be considered to be first diagnosis choice when patient have already underwent posterior spinal fusion surgery, compared to the cases previous reported that the surgery still did not begin. Nevertheless, we managed to complete our partially completed surgery in a lateral prone position by one stage in a creative way. This report provides sufficient and logical differential diagnosis for the management of intraoperative hypotension associated with prone position. Moreover, our case strongly suggests that more detailed preoperative assessments are necessary to identify the potential risk of prone position on intraoperative blood pressure in scoliosis patients with pectus excavatum or Marfan's-like feature.