Advertisement

Management of Patient with Lumbar PIVD

  • Adam Yu Yuan
  • Saket Singh
Chapter
  • 22 Downloads

Abstract

Spine surgery is performed for correction of various deformities and pathologies; although surgeons employ various approaches and techniques, the broad aims of anesthetic management are quiet similar. The aims include but are not limited to perioperative risk reduction, minimizing intraoperative risk, tailoring the anesthetic based on unique patient factors and the neuro-monitoring being applied, blood conservation and pain management. Managing patient expectations, educating the patient about the unique complications related to spine surgeries, and shared decision-making, especially regarding pain management, have demonstrated usefulness in enhancing the patient experience.

Keywords

Spine surgery Intraoperative blood salvage Postoperative dysphagia SSEP MEP Postoperative visual loss (POVL) Peripheral nerve injury PONV Dexamethasone Tranexamic acid Gabapentin 

References

  1. 1.
    Comfere T, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg. 2005;36:644.Google Scholar
  2. 2.
    Castanheira L, et al. Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther. 2011;36(4):446–67.CrossRefGoogle Scholar
  3. 3.
    Liu B, et al. A meta-analysis of the preoperative use of gabapentinoids for treatment of acute postoperative pain following spinal surgery. Medicine. 2017;96(37):e8031.CrossRefGoogle Scholar
  4. 4.
    Pajewski TN, et al. Anesthesia for anterior/posterior spine surgery. In: Traul DE, Osborn IP, editors. Neuroanesthesia: a problem-based learning approach. Oxford: Oxford University Press; 2019. p. 87–97.Google Scholar
  5. 5.
    Carabini LM, et al. Hemostasis and transfusion medicine. In: Barash PG, et al., editors. Clinical anesthesia. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 429–31.Google Scholar
  6. 6.
    Cardone D, et al. Perioperative blood conservation. Eur J Anesthesiol. 2009;26(9):722–9.CrossRefGoogle Scholar
  7. 7.
    Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J. 2013;95B(7):868–73.Google Scholar
  8. 8.
    Sutter M, et al. The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients. Eur Spine J. 2019;28(3):599–610.  https://doi.org/10.1007/s00586-018-5861-0.CrossRefPubMedGoogle Scholar
  9. 9.
    Cofano F, et al. Intraoperative neurophysiological monitoring during spinal surgery: technical review in open and minimally invasive approaches. Neurosurg Rev. 2019;42(2):297–307.  https://doi.org/10.1007/s10143-017-0939-4.CrossRefPubMedGoogle Scholar
  10. 10.
    Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116(1):15–24.Google Scholar
  11. 11.
    American Society of Anesthesiologists Task Force on Perioperative Visual loss. Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology. 2012;116(2):274–85.CrossRefGoogle Scholar
  12. 12.
    Hewson DW, et al. Peripheral nerve injury arising in anesthesia practice. Anesthesia. 2018;73(Suppl.1):51–60.CrossRefGoogle Scholar
  13. 13.
    Corcoran T, et al. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX). Br J Anaesth. 2017;118(2):190–9.CrossRefGoogle Scholar
  14. 14.
    Assante J, et al. Infection associated with single-dose dexamethasone for prevention of postoperative nausea and vomiting: a literature review. AANA J. 2015;83(4):281–8.PubMedGoogle Scholar
  15. 15.
    Malafa MM, et al. Perioperative corneal abrasion updated guidelines for prevention and management. Plast Reconst Surg. 2016;137:790–8e.CrossRefGoogle Scholar
  16. 16.
    Mathiesen O, et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J. 2013;22:2089–96.CrossRefGoogle Scholar
  17. 17.
    Gritsenko K, et al. Multimodal therapy in perioperative analgesia. Clin Anesth. 2014;28:59–79.Google Scholar
  18. 18.
    Himmelseher S, et al. Ketamine for perioperative pain management. Anesthesiology. 2005;102:211–20.CrossRefGoogle Scholar
  19. 19.
    Loftus RW, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113:639–46.PubMedGoogle Scholar
  20. 20.
    Ortiz-Cardona J, et al. Perioperative pain management in the neurosurgical patient. Anesthesiol Clin. 2007;25:655–74.CrossRefGoogle Scholar
  21. 21.
    Pradhan BB, et al. Ketorolac and spinal fusion. Spine. 2008;33:2079–82.CrossRefGoogle Scholar
  22. 22.
    Li G, et al. Efficacy of antifibrinolytic agents on surgical bleeding and transfusion requirements in spine surgery: a meta-analysis. Eur Spine J. 2017;26(1):140–54.CrossRefGoogle Scholar
  23. 23.
    Duggan EW, et al. Perioperative hyperglycemia management: an update. Anesthesiology. 2017;126(3):547–60.CrossRefGoogle Scholar
  24. 24.
    Lou W, et al. The effect of diabetes on perioperative complications following spinal surgery: a meta-analysis. Ther Clin Risk Manage. 2018;14:2415–23.CrossRefGoogle Scholar
  25. 25.
    Guzman JZ, et al. Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine. 2014;39(19):1596–604.CrossRefGoogle Scholar
  26. 26.
    Qaseem A, et al. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575–80.CrossRefGoogle Scholar
  27. 27.
    Murgai R, et al. Incidence of respiratory complications following lumbar spine surgery. Int J Spine Surg. 2018;12(6):718–24.CrossRefGoogle Scholar
  28. 28.
    Pawar AY, et al. Postoperative spine infections. Asian Spine J. 2016;10(1):176–83.CrossRefGoogle Scholar
  29. 29.
    Koutsoumbelis S, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am. 2011;93:1627–33.CrossRefGoogle Scholar
  30. 30.
    Christodoulou AG, et al. Reduction of postoperative spinal infections based on an etiologic protocol. Clin Orthop Relat Res. 2006;444:107–13.CrossRefGoogle Scholar

Suggested Reading

  1. American Society of Anesthesiologists Task Force on Perioperative Visual loss. Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology. 2012;116(2):274–85.CrossRefGoogle Scholar
  2. Mathiesen O, et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J. 2013;22:2089–96.CrossRefGoogle Scholar
  3. Pajewski TN, et al. Anesthesia for anterior/posterior spine surgery. In: Traul DE, Osborn IP, editors. Neuroanesthesia: a problem-based learning approach. Oxford: Oxford University Press; 2019. p. 87–97.Google Scholar
  4. Sutter M, et al. The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients. Eur Spine J. 2019;28(3):599–610.  https://doi.org/10.1007/s00586-018-5861-0.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Adam Yu Yuan
    • 1
  • Saket Singh
    • 2
  1. 1.Allegheny General Hospital, Allegheny Health NetworkPittsburghUSA
  2. 2.Piedmont Medical CenterRock HillUSA

Personalised recommendations