scoliosis is the summer surgery

Summer is a time for big spine surgeries in our OR. Teenage kids are out of school, so they come in to get it done during their summer break. Recovery is long and may be painful. Usually they are healthy otherwise, and although it is a huge surgery they do very well. But today it's a different story - 12 years old girl with severe cerebral palsy and tons of problems - seizure, post heart surgery (Fontan), G-tube (permanent feeding tube) and no veins. Dad was very nice and actually helpful in preop area. Initially I thought of getting IV access in preop, but after i talked to him and looked at her veins (rather on the absence of them) it became obvious that it would be better to put her to sleep with a mask and then look for a vein. So she got some Versed through her G-tube, and became really mellow with that. Mask induction was easy enough, and then one of those "better be lucky then good" just happened! I got an IV in, not a big one, just 22g, but it's a good start. The arterial line followed. Central line went into the neck - left IJ (internal jugular Vein) and we were ready to roll.
What I learn over the years about scoliosis surgery is that it is really surgeon dependent. When I was in my training, residency and fellowship, it would be whole day adventure with tons of blood loss. Patients would stay intubated (asleep with a breathing tube) at least overnight, we had to do all these (seemed advanced at the time) anesthesia techniques to slow down blood loss as much as possible (we would keep patients'blood pressure intentionally low, or take some blood from them in the beginning of the case, replace it with Ringer solution and give the blood back at the end of the case). When I started working on my own, with private surgeons, these cases stopped being as big of a deal anymore. We still get ready for a serious blood loss - large bore IVs, blood in the OR, ICU admission after surgery, but It takes only 4-5 hours, blood loss is there, but nothing unmanageable, and there were a few times when i didn't have to give blood at all.
We did transfuse our patient today, I think we lost about 900cc, and I did keep her intubated (it was more conservative approach then usual). Surgeons put epidural catheter in her back, for pain management after surgery, I have to take care of it now - they work in most of the scoliosis kids, but some require a little more attention. OK, gotta go now - my next challenge for today - 3 year old for an MRI study.