Anesthetic considerations during spine surgery

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Health & Medicine

SPINE SURGERY:
NAVIGATING
COMPLICATIONS
Dr. Chaula Doshi
HOD & Professor, Department of
Anesthesia

INDICATIONS OF SPINE
SURGERY
• NEUROLOGICAL DYSFUNCTION DUE TO
COMPRESSION
• PATHOLOGICAL LESIONS DUE TO TUMORS OR
INFECTION
• DEFORMITY
• PAIN
• STRUCTURAL INSTABILITY
• FRACTURES
2

TYPES OF SPINE SURGERY
• SPINAL DECOMPRESSION
PROCEDURES INCLUDING
LAMINECTOMY, DISCECTOMY,
FORAMINOTOMY,
FACECTOMY,
VERTEBROPLASTY ETC
• SPINAL FUSION PROCEDURES
• SPINAL FIXATION AND
INSTRUMENTATION
• DEFORMITY CORRECTION
SURGERIES FOR KYPHOSIS
AND SCOLIOSIS
• SURGERY FOR CORD
TUMORS
• OPEN
• MINIMALLY INVASIVE
• LAPAROSCOPIC
• ROBOTIC
3

NAVIGATING THROUGH THE
COMPLICATIONS
INTRAOPERATIVE POSTOPERATIVE

PRONE POSITIONING DURING
SPINE SURGERY
5

IMPROPER POSITIONING :
Issue: ETT kinking or
dislodgement.
Solution: Use of Armored
tube, Throat pack and
antisialagogue to prevent
secretions, proper
positioning
Issue: POVL due to
Ischemic optic
neuropathy or central
retinal vessel occlusion,
Corneal abrasions, tear
Solution: Proper Eye
padding to prevent
compression
Abdominal Compression,
Increase of intra-
abdominal Pressure.
Solution: Soft Supports
Nerve compression, Deep
vein thrombosis
Solution: Soft supports
6
1
2
3
4

DURING INTUBATION
• AWAKE OR ASLEEP INTUBATION
• DIRECT LARYNGOSCOPY AFTER MANUAL IN
STABILIZATION OR RIGID COLLAR
• VIDEO LARYNGOSCOPY
• FIBREOPTIC LARYNGOSCOPY IN CASE OF CERVICAL
SPINE DEFORMITIES, FRACTURE, LIMITED NECK
MOVEMENT OR MOUTH OPENING OR ANY CERVICAL
UNSTABILITY
• USE OF ARMOURED ENDOTRACHEAL TUBES TO
PREVENT KINKING DURING PRONE POSITIONING
7

BLOOD LOSS AND
TRANSFUSION
• EBL IN DEFORMINTY CORRECTION IS 3-5L.
• ADEQUATE BLOOD AND BLOOD PRODUCTS TO
BE ARRANGED
• HYPOTENSIVE ANESTHESIA
• ANTIFIBRINOLYTIC THERAPY
• MASSIVE BLOOD TRANSFUSION PROTOCOL
8

NEUROLOGICAL MONITORING
11
SOMATOSENSORY
EVOKED POTENTIAL
MOTOR EVOKED
POTENTIAL
ELECTROMYOGRAPHY WAKEUP TEST

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