Survey of anesthesia practice in spine surgery patients in the United States

Blinder, Jordan L.; El-Mansouri, Mervat; Connelly, Neil Roy

doi:10.1007/s005400300002

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…Well-recognised risks of scoliosis surgery are major blood loss and high transfusion requirements 17,18 ; interventions to minimise blood loss varied between institutions influenced by varying efficacies, safety and cost considerations. The techniques employed were similar to those previously reported in 2003 1 , except for less preoperative autologous donation in paediatric scoliosis surgery. Combining available blood-sparing techniques synergistically reduces allogenic transfusion requirements 19 .…”

Section: Discussionmentioning

confidence: 87%

“…Regarding anaesthesia maintenance, institutions favour inhalational over a TIVA-propofol technique, as reported previously 1 , and both techniques are used equally for CMAP monitoring, as suggested in the literature 8 . Published comparisons of inhalational and TIVA-propofol techniques demonstrate no differences in recovery time, emergence delirium and postoperative nausea, vomiting or pain 3 .…”

Section: Discussionmentioning

confidence: 93%

“…The previous North American survey reported no antifibrinolytic use 1 , while the surveyed institutions and North American paediatric scoliosis centres (personal communication: pac@anaes.sickkids. on.ca) use them widely.…”

Section: Discussionmentioning

confidence: 99%

“…The range or frequency of use of the various practices is unknown. A 2003 survey of American anaesthesiologists' practice for spinal surgery was published 1 with a small scoliosis focus (19%) and wide reported anaesthetic practice variation. The same survey identified the frequent use of preoperative autologous donation (84%), cell-saving (87%) and controlled hypotension (CH) (employed with intravenous [IV] sodium nitroprusside, IV labetalol and deepening of inhaled volatile anaesthetic agent) as allogenic bloodsparing techniques.…”

mentioning

confidence: 99%

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A Multi-Centre Multi-National Survey of Anaesthetists Regarding the Range of Anaesthetic and Surgical Practices for Paediatric Scoliosis Surgery

Palmer

Pirakalathanan

Skinner

2010

Anaesth Intensive Care

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Institutional responses to a detailed multinational survey were used to characterise the range of current anaesthetic and surgical practices for paediatric scoliosis surgery. Questions addressed surgical practice, anaesthetic agents, blood-sparing techniques, neurophysiological monitoring used and recalled major complications. Twenty-seven (87%) institutions responded. The median number of cases of these institutions was 40 per year (range 5 to 700). Common practices included inhaled volatile anaesthetic maintenance (80%), omission of nitrous oxide (81%), intravenous remifentanil (88% [range 0.05 to 2.00 µg.kg-1 .min-1 ]), and double intravenous antiemetic agent prophylaxis (59%); multimodal analgesia with paracetamol and parenteral opioids, non-steroidal antiinflammartory drugs and epidural local anaesthetic or opioid infusion (UK) and intrathecal opioids and subanaesthetic doses of intravenous ketamine by infusion (Australia); use of cell-saver (81%), controlled hypotension (77%) and antifibrinolytic agents (74%) (intravenous aprotinin [59%] or tranexamic acid [44%]); and epidural somatosensory (92%), neurogenic motor-evoked (32%), compound motor action (31%) and transcranial motorevoked potential monitoring (54%), with routine wake-up test used infrequently (19%). Fifty-four neurological or cardiac adverse events or deaths were recalled. While institutional practices varied, common themes were identified. The information obtained may suggest new strategies to various centres and could be useful for planning multi-centre audits and trials.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Multi-Centre Multi-National Survey of Anaesthetists Regarding the Range of Anaesthetic and Surgical Practices for Paediatric Scoliosis Surgery

Palmer

Pirakalathanan

Skinner

2010

Anaesth Intensive Care

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“…Intraoperative neuromonitoring is available in most institutions in the United States and is frequently used during spine surgery [69] . Commonly used intraoperative neuromonitoring modalities are somatosensory evoked potential (SSEP) and motor evoked potential.…”

Section: Intraoperative Neuromonitoringmentioning

confidence: 99%

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Kamel

Barnette

2014

WJO

111

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Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury (PPNI) and postoperative visual loss (POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic optic neuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL. It is important for spine surgeons to be aware of PPNI and POVL to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters.Kamel I, Barnette R. Positioning patients for spine surgery: Avoiding uncommon position-related complications. World J Orthop

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Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire

et al. 2007

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Survey of anesthesia practice in spine surgery patients in the United States

Abstract: The most frequent monitoring utilized for major spinal surgeries is SSEP. Autologous donation and intraoperative salvage are the most frequent blood conservation methods utilized.

Cited by 9 publications

References 25 publications

A Multi-Centre Multi-National Survey of Anaesthetists Regarding the Range of Anaesthetic and Surgical Practices for Paediatric Scoliosis Surgery

A Multi-Centre Multi-National Survey of Anaesthetists Regarding the Range of Anaesthetic and Surgical Practices for Paediatric Scoliosis Surgery

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire

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