Anaesthesia for spinal surgery in adults

Raw, David; Beattie, J.K.; Hunter, Jennifer M.

doi:10.1093/bja/aeg253

Cited by 168 publications

(98 citation statements)

References 117 publications

(90 reference statements)

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“…14 Patients with severe cervical cord injuries are more prone to hemodynamic and cardiac abnormalities within the first 1-2 weeks after injury. 1,2 Lehmann et al 1 found hypotension in 68% of the studied patients with SCI with complete cervical cord injury and no hypotension in either incomplete cervical or thoracolumbar cord injuries.…”

Section: Resultsmentioning

confidence: 99%

“…25 At that time, reflex hyperactivity begins manifesting as muscle spasms and elevation of blood pressure. 14,26 Furthermore, Ko and coworkers 27,28 specified that the time of return of deep tendon reflexes after SCI is within the first couple of weeks after injury with the delayed plantar reflex being the first followed by the bulbocavernous and cremasteric reflex. However, no established connection between spinal shock and neurogenic shock does exist.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of the evidence supporting a role for vasopressor support in acute SCI

et al. 2009

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Study design: A systematic review of clinical and preclinical literature. Objective: To critically evaluate the evidence supporting a role for vasopressor support in the management of acute spinal cord injury and to provide updated recommendations regarding the appropriate clinical application of this therapeutic modality. Background: Only few clinical studies exist examining the role of arterial pressure and vasopressors in the context of spinal cord trauma. Methods: Medical literature was searched from the earlier available date to July 2009 and 32 articles (animal and human literature) answering the following four questions were studied: what patient groups benefit from vasopressor support, which is the optimal hypertensive drug regimen, which is the optimal duration of the treatment and which is the optimal arterial blood pressure. Outcome measures used were the incidence of patients needing vasopressors, the increase of arterial blood pressure and neurologic improvement. Results: Patients with complete cervical cord injuries required vasopressors more frequently than either incomplete injuries or thoracic/lumbar cord injuries (Po0.001). There was no statististical difference in neurologic improvement between patients on vasopressor support with a mean arterial pressure (MAP) of less than 85 mm Hg and those with MAP less than 90 mm Hg. Duration of treatment is often recommended between 5 and 7 days although this is not supported by high-level evidence and no single vasopressor appeared superior over the variety used in clinical treatment. Conclusion: There is currently no gold standard on vasopressor support. Based on non-randomized human studies, complete cervical cord injuries require vasopressors more frequently than other spinal cord injuries.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review of the evidence supporting a role for vasopressor support in acute SCI

et al. 2009

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“…The exact mechanism of potentiation of vasoconstriction by clonidine remains unclear. Although Tanaka and Nishikawa attribute this vasoconstrictive action of clonidine to postjunctional alpha-1 adrenoceptor agonism (29), Talke et al suggest that clonidine acts on the alpha-2b subtype of alpha-2 adrenoreceptors in peripheral vascular smooth muscle to cause vasoconstriction (32).…”

Section: Discussionmentioning

confidence: 99%

“…Factors other than blood pressure, postulated to affect intra-operative blood loss include intra-abdominal pressure (related to prone positioning), the number of spinal segments being operated on, body weight, the pathological entity of the disease necessitating surgery (spine surgery due to tumoral lesions is associated with more bleeding), and surgeon's experience (32). In our study, all patients were operated due to traumatic fractures of the spine on 3 to 4 spinal segment levels and by the same surgical team.…”

Section: Discussionmentioning

confidence: 99%

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

et al. 2012

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The addition of oral clonidine to anesthetic management of spine surgery offers clinical advantages. Further dose-finding studies in more complicated spine surgeries are warranted. BackgroundSpinal fusion surgery is often associated with major blood loss, which is sometimes significant, requiring the transfusion of blood or blood products (1). Blood loss can be an acute problem not only in major deformity surgery but also in less extensive fusion procedures. DecreasingBackground: Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty. Objectives: In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil. Patients and Methods:In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-µg oral clonidine tablet 60-90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/ hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon's satisfaction of a bloodless field between groups. Results: There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390). Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group (P = 0.002 and P = 0.001, respectively), but there was no significant difference in surgeon's satisfaction between groups (P = 0.169). Conclusions: As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.

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“…[4] Scoliosis should be treated at the proper time because especially idiopathic scoliosis has a rapidly progress and may be fatal following the possible complications. [5] Some other types of scoliosis may also have dangerous medical conditions. [6] It is clear that scoliosis has a multifactorial etiology and it is generally presented in idiopathic type.…”

mentioning

confidence: 99%

Kyphoscoliosis and difficult airway management

Saraçoğlu¹

2015

FNG & Bilim Tıp Dergisi

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Kyphoscoliosis is generally idiopathic and female dominant disease and the prevalence can vary between 0.3-15.3%. Anesthesia for both adult and pediatric patients with scoliosis can present a variety of challenges, because of some other diseases accompany to scoliosis. One of challenges is airway management. Problems with airway management may be fatal for patients. Basic preparations should be ready for airway management in a situation of unanticipated difficult airway. Besides there should be more than one plan and practitioners. If a strategy fails one should quickly change to another approach. Appropriate equipment beginning from laryngoscopes to a cricothyroid puncture kit should be available regarding practitioner's experience on devices. Extubation of a patient with difficult airway is important as tracheal intubation. Low reintubation rates and patient comfort are the most important issues for the extubation of patients with difficult airway.Keywords: Anesthesia; difficult airway; kyphoscoliosis. Kifoskolyoz ve zor havayolu yönetimi ÖZKifoskolyoz genel olarak idiopatik ve kadın dominant bir hastalıktır ve prevalansı %0.3-15.3 arasında değişebilir. Eşlik eden bazı hastalıklar nedeniyle gerek erişkin gerekse de pediatrik skolyoz hastaları için anestezi birçok zorluklar içerebilmektedir. Zorluklardan biri havayolu yönetimidir. Havayolu yönetimiyle ilgili sorunlar hastalar için ölümcül olabilir. Beklenen yada beklenmeyen zor havayolu durumu için temel hazırlıklar hazır bulundurulmalıdır. Bununla birlikte birden fazla plan ve uygulayıcı olmalıdır. Eğer bir stratejide başarısızlık olursa hızlıca diğer yaklaşıma geçilebilmelidir. Uygulayıcının aygıtlar üzerindeki deneyimine göre laringoskoplardan krikoidotomi kitine kadar uygun ekipman bulundurulmalıdır. Bir zor havayolu hastasının ekstübasyonu trakeal entübasyon kadar önemlidir. Düşük reentübasyon oranları ve hasta konforu zor havayoluna sahip hastaların ekstübasyonu için en önemli konulardandır.

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Anaesthesia for spinal surgery in adults

Cited by 168 publications

References 117 publications

A systematic review of the evidence supporting a role for vasopressor support in acute SCI

A systematic review of the evidence supporting a role for vasopressor support in acute SCI

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

Kyphoscoliosis and difficult airway management

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