Anesthetic considerations in spine surgery: What orthopaedic surgeon should know!

Khanna, Puneet; Sarkar, Soumya; Garg, Bhavuk

doi:10.1016/j.jcot.2020.05.005

Cited by 10 publications

(10 citation statements)

References 51 publications

(41 reference statements)

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“…[17][18][19] It is important to note that most studies published regarding spine ERAS pathways included patients undergoing either 1-level or 2-level surgery rather than complex spine surgeries including > 2 levels. 244 Recommendation: (1) Institutions may form a multidisciplinary team of experts for the following reasons (Class I, Level of Evidence C-EO):…”

Section: Continued Review Of Institutional Eras Pathwaysmentioning

confidence: 99%

“…However, other studies found no decrease in length of stay18,21,22 and no reduction in 30-day readmission rates17 or 30-day complication rates 17–19. It is important to note that most studies published regarding spine ERAS pathways included patients undergoing either 1-level or 2-level surgery rather than complex spine surgeries including >2 levels 244…”

Section: Evidence-based Clinical Practice Guidelines and Recommendationsmentioning

confidence: 99%

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Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Blacker

Vincent

Burbridge

et al. 2021

Journal of Neurosurgical Anesthesiology

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Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.

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Section: Continued Review Of Institutional Eras Pathwaysmentioning

confidence: 99%

Section: Evidence-based Clinical Practice Guidelines and Recommendationsmentioning

confidence: 99%

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Blacker

Vincent

Burbridge

et al. 2021

Journal of Neurosurgical Anesthesiology

View full text Add to dashboard Cite

show abstract

“…When the patient is placed in the prone position for surgical procedures, the anesthesia provider must optimize care to avoid the problems with the airway management (potential displaced ETT), ventilation, hemodynamic instability, position-related injuries (e.g. postoperative visual loss-POVL, peripheral nerve injury (PNI), and spinal cord injury) [ 23 ]. During one-lung ventilation for thoracotomy, anesthesia providers should employ a protective ventilation strategy, which includes maintenance of low tidal volume (TV), low airway pressure, low positive end expiratory pressure (PEEP) and keep minimum oxygen (O 2 ) concentrations to avoid lung injury.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Intercostal Nerve Cryoneurolysis for Post-Thoracotomy Pain Control: A Case Discussion

Lu¹,

Miao²,

Sandra³

et al. 2022

Transl Perioper & Pain Med

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involvement and brachial plexus compression (Figure 1). A biopsy of the mass was reported as mesenchymal chondrosarcoma. After chemotherapy and radiation therapy, some of his symptoms, including right arm pain improved and the total tumor volume was slightly reduced. The patient was not taking pain medication at the time he was referred to our hospital for neuro/ thoracic surgical consultations for possible tumor resection.On admission, the patient stated he has been doing well, and denied shortness of breath, dyspnea on exertion, nausea, vomiting or worsening right arm sensory/motor dysfunction. His physical exam, laboratory studies, echocardiogram, electrocardiogram (EKG), chest X-ray (CXR) and pulmonary function testing (PFT), chest computed tomography (CT) scan and magnetic resonance imaging (MRI) were all stable. Surgical plans and proceduresTo start the case, the neurosurgeon placed the patient in the prone position to facilitate the dorsal approach to the right of T1-T4 spinous processes and corresponding vertebral bodies. At the level of T2 and T3, the transverse processes were transected, ribs disarticulated and the nerve roots ligated. The patient was then repositioned into the left decubitus position for the chest wall tumor resection including en bloc resection of a portion of T2 and T3 transverse processes (no reconstruction) (Figure 2).After the tumor was resected, the thoracic surgeons performed intercostal cryoneurolysis (IC) of the threelevel of ribs encompassing the surgical incision. The cryoprobe (cryoICE TM, Atricure Inc., Ohio) was placed into the thoracic cavity under direct visualization. It touched the membranous portion of the right fourth through sixth intercostal space, 4 cm away from the base of the spine to avoid iatrogenic injury to the sympathetic ganglia chain (Figure 3). Each nerve was frozen for 120 sec with a tip temperature between -50 °C to -70 °C. After the cryoneurolysis, the thoracic surgeon re-inspected the chest, established hemostasis

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“…Clinical advances in technology and improvement are now addressing a broader spectrum of diseases, from single-level decompression to multistage exhaustive reconstruction. The number of patients is rapidly increasing due to the epidemic of persistent low back pain and the emergence of surgical procedures that are minimally invasive 1. Given the higher patient tolerance, a secure and safe airway, with better surgical exposure under muscle relaxants, general anaesthesia (GA) is frequently recommended for all types of spinal surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Combined segmental spinal epidural for major spine surgery: a case report

Parthasarathy,

Hussain

2024

BMJ Case Rep

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A woman in her mid-50s, hesitant about general anaesthesia due to a difficult airway, opted for neuraxial anaesthesia for L4 laminectomy with pedicle screw fixation (L3–L5). Preoperatively, she received 150 µg buprenorphine and 1 mg midazolam. In lateral position, a T8–T9 epidural catheter was placed, followed by segmental spinal anaesthesia (2.5 mL 0.5% hyperbaric bupivacaine+30 µg clonidine) at T10–T11. Prone positioning was executed using standard techniques. During the 6–7 hours surgery, three 7 mL epidural top-ups (2% lignocaine epinephrine) were administered at 90 min intervals. Haemodynamics remained stable with 2.5 L crystalloids, 350 mL packed red cells and three ephedrine doses (6 mg each). Sedation included 150 µg buprenorphine and two 1 mg midazolam doses. Postoperatively, she received epidural 0.25% bupivacaine for 2 days, systemic analgesics and was discharged on the sixth day.

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Anesthetic considerations in spine surgery: What orthopaedic surgeon should know!

Cited by 10 publications

References 51 publications

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Intraoperative Intercostal Nerve Cryoneurolysis for Post-Thoracotomy Pain Control: A Case Discussion

Combined segmental spinal epidural for major spine surgery: a case report

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