Application of Controlled Hypotension During Surgery for Spinal Metastasis

Abstract

With advances in tumor treatment, metastasis to bone is increasing, and surgery has become the only choice for most terminal patients. However, spinal surgery has a high risk and is prone to heavy bleeding. Controlled hypotension during surgery has outstanding advantages in reducing intraoperative bleeding and ensuring a clear field of vision, thus avoiding damage to important nerves and vessels. Antihypertensive drugs should be carefully selected after considering the patient's age, different diseases, etc, and a single or combined regimen can be used. Hypotension also inevitably leads to a decrease in perfusion of important organs, so the threshold of hypotension and the maintenance time of hypotension should be strictly limited, and the monitoring of important organs during the operation is particularly important. Information such as blood perfusion, blood oxygen saturation, cardiac output, and neurophysiological conduction potential changes should be obtained in a timely fashion, which will help to reduce the risk of hypotension. In short, when applying controlled hypotension, it is necessary to choose an appropriate threshold and duration, and appropriate monitoring should be conducted during the operation to ensure the safety of the patient.

Management of Incidental Uncontrolled Elevation of Intraoperative Blood Pressure: A Comparative Study on Nitroglycerine Versus Dexmedetomidine Infusion

“…Cancer resection surgeries usually have a complex extensive operative field. Consequently, proper control of intraoperative blood pressure results in a clearer surgical field with lower incidence of operative blood loss ( 7 ). Intraoperative hypertension can be encountered in hypertensive patients undergoing surgeries under general anesthesia.…”

“…It was noticed that the rapid infusion of dexmedetomidine loading dose over less than 10 min can lead to hypertension through activating peripheral α2a receptors, while slow infusion results in the activation of central α2a receptors with the subsequent inhibition of noradrenaline release and lowering of HR and blood pressure ( 5 ). Moreover, dexmedetomidine infusion has a neuroprotective effect with reducing cerebral oxygen consumption and decreased incidents of cognitive dysfunction postoperatively ( 7 ). In the current study, we observed that patients who received dexmedetomidine infusion showed more hemodynamic stability with fewer episodes of intraoperative hypotension, tachycardia, and rebound elevation of blood pressure after discontinuation of the drug infusion.…”

Effects of a ‘Rebuilding Myself’ intervention on enhancing the adaptability of cancer patients to return to work: a randomized controlled trial

“…As reported by the World Health Organization, the International Agency for Research on Cancer predicts that there will be 28.4 million new cases of cancer worldwide by 2040, an increase of 47% compared to 2020 [ 2 ]. Recently, the incidence of cancer in China has been steadily increasing [ 3 ], and what’s more, virtually all cancer types are becoming more common in younger age groups [ 4 ]. According to the Chinese Cancer Control Center [ 5 ], more than 1.4 million new cancer survivors are born every year.…”

Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

“…Controlled hypotension has advantages, including reducing intraoperative bleeding, ensuring clear surgical visibility, avoiding damage to important nerves and blood vessels, shortening the operation time, and lessening tissue edema; hence, it has been widely used in various clinical operations. [ 4 , 5 ] However, it is seldom used in TKA. Certainly, there are other reasons for the insufficient study of controlled hypotension technology in TKA.…”