Causal factors for position-related SSEP changes in spinal surgery

Silverstein, Justin W.; Matthews, Eric; Mermelstein, Laurence E.; DeWal, Hargovind

doi:10.1007/s00586-016-4618-x

Cited by 9 publications

(2 citation statements)

References 41 publications

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“…To prevent this rare, but catastrophic event, intraoperative neuromonitoring should be used as it allows for early detection of spinal cord hypoperfusion and can consequently prevent permanent neurological deficits in the overwhelming majority of cases. [59][60][61] Hypotensive anesthesia (MAP 70 mm Hg) may be best reserved for the approach and instrumentation, where bleeding risk is highest. However, we recommend maintaining the MAP above 80 mm Hg while manipulating the neural elements to decrease the likelihood of ischemic tissue injury.…”

Section: Hypotensive Anesthesiamentioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

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Section: Hypotensive Anesthesiamentioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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“…Being able to pinpoint the location of the pressure before it affects the patient would be ideal so that repositioning can occur before the injury becomes irreversible. 10 In today's ORs, we have an abundance of supplies and devices we can use to position the patient correctly. In addition, the mattress that the patient lies on is critical to the prevention of pressure injury.…”

Section: Correct Positioningmentioning

confidence: 99%

The Key to Safety: Proactive Prevention

Davis¹

2018

AORN Journal

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M any times in my career, I have looked back on the patient care I have provided and thought about what I could or should have done that might have led to an even better result. Being reflective about our practice and discussing it with our knowledgeable colleagues often will provide us with new ideas. These ideas can motivate us to seek out what, if any, evidence exists to support a new patient care practice.In nursing, we must be vigilant lifelong learners. The data and science behind our practice is ever changing. It is imperative that we know and implement the most current evidence to prevent harm to our patients and promote the best possible outcomes. Advanced planning, or as many of us know it, "the plan of care," is what distinguishes nurses' contributions to the perioperative arena in a positive and productive way.One of the ways perioperative nurses proactively contribute to the prevention of harm in the OR is by correctly positioning patients for each and every procedure. Surgical positions are often complicated, and maintaining the patient's proper body alignment can be a challenge. Each year, an estimated 2.5 million patients in US health care facilities develop pressure injuries, and these injuries lead to death for approximately 60,000 patients annually. 1 Even more concerning is the high rate of pressure injuries for patients undergoing surgical procedures, estimated at 8.5% for procedures that last longer than three hours. 2 Overall, pressure injuries that develop in the perioperative setting are estimated to account for 45% to 66% of all health care-associated pressure injuries. 2,3 This is a much higher percentage than many of us would have believed, and this problem certainly requires our attention. CORRECT POSITIONINGYears ago, before we had the advanced positioning devices and supplies we have today, we used a variety of items to help position a patient. We might have used everything from a rolled-up sheet to an IV fluid bag. Today, we know much more about what is effective for positioning a patient to reduce the risk of injury. For example, we know that pillows, blankets, and molded foam devices are not effective for pressure distribution. Towels and sheet rolls do not reduce pressure and may even cause a positioning injury as a result of friction. 4Being the patient's advocate requires knowledge of the correct positioning practices. Too often we hurry through the positioning process without taking the time to really evaluate the patient's risks and mitigate them. Core concepts we should keep in mind include, but are not limited to, the following.• Injuries resulting from improper positioning are preventable and are a liability.• Surgical patients are often in unnatural positions and are unable to communicate or adjust to alleviate their discomfort or pain. It is up to the surgical team to identify and correct any problems in the patient's position.• Personnel should communicate and document all positioning interventions before, during, and after the procedure and communicate all relevant po...

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