Preoperative cardiopulmonary assessment in the child with neuromuscular scoliosis.

Preoperative cardiopulmonary assessment in the child with neuromuscular scoliosis comprises two successive steps. The first is the exclusion of any preoperative factor which could make the surgery too dangerous or unacceptable, unless corrected (e.g. clotting problems, decompensated cardiomyopathy, respiratory insufficiency, etc). The second is more functional, and consists of detecting potentially higher risks of postoperative alveolar hypoventilation and secretion removal insufficiency. The authors propose a logical decision-making tree, which can identify the most essential items. Preoperative assessment is a progressive evaluation of an acceptable or unacceptable cost-benefit ratio, which can best be achieved by spending time and discussing all aspects with the patient and family.