Skip to main content
SpringerLink
Log in

Controlled hypotension for spinal surgery

  • Conference paper
Haemostasis in Spine Surgery

Abstract

Controlled, deliberate hypotension during anesthesia for major spinal surgery reduces intraoperative blood loss and transfusion requirement. Hypotension may be achieved with increased doses of volatile anesthetic agents or by continuous infusion of vasodilating drugs. Safe application of this technique requires knowledge of the physiology of hemorrhagic shock and close intraoperative monitoring to avoid vasoconstriction and endorgan ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abramson D, Scalea TM, Hitchcock et al (1993) Lactate clearance and survival following injury. J Trauma 35:584–8

    PubMed  Google Scholar 

  2. Beaussier M, Paugam C, Deriaz H, Mestari M, Chandon M, Sautet A, Lienhart A (2000) Haemodynamic stability during moderate hypotensive anaesthesia for spinal surgery. A comparison between desflurane and isoflurane. Acta Anaesthesiol Scand 44: 1154–1159

    Article  PubMed  Google Scholar 

  3. Bernard JM, Passuti N, Pinaud M (1992) Long-term hypotensive technique with nicardipine and nitroprusside during isoflurane anesthesia for spinal surgery. Anesth Analg 75:179–185

    PubMed  Google Scholar 

  4. Bernard JM, Le Penven-Henninger C, Passuti N (1995) Sudden decreases in mixed venous oxygen saturation during posterior spinal fusion. Anesth Analg 80:1038–1041

    Article  PubMed  Google Scholar 

  5. Blow O, Magliore L, Claridge JA et al (1999) The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma 47:964–969

    PubMed  Google Scholar 

  6. Brodsky JW, Dickson JH, Erwin WD, Rossi CD (1991) Hypotensive anesthesia for scoliosis surgery in Jehovah’s Witnesses. Spine 16:304

    PubMed  Google Scholar 

  7. Committee on Trauma, American College of Surgeons (1997) Advanced Trauma Life Support Program for Doctors. American College of Surgeons, Chicago, pp 89–107

    Google Scholar 

  8. Dilger JA, Tetzlaff JE, Bell GR et al (1998) Ischaemic optic neuropathy after spinal fusion. Can J Anaesth 45:63

    PubMed  Google Scholar 

  9. Dutton RP (2002) Management of traumatic shock. In: Prough DS, Fleisher L (eds) Problems in anesthesia: trauma care. Lippincott, Philadelphia, 13(3)

    Google Scholar 

  10. Grundy BL, Nash CL, Brown RH (1982) Deliberate hypotension for spinal fusion: prospective randomized study with evoked potential monitoring. Can Anaesth Soc J 29:452

    PubMed  Google Scholar 

  11. Hickey RF, Verrier ED, Baer RW, Vlahakes GJ, Fein G, Hoffman JI (1983) A canine model of acute coronary artery stenosis: effects of deliberate hypotension. Anesthesiology 59: 226–236

    PubMed  Google Scholar 

  12. Hur SR, Huizenga BA, Major M (1992) Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine 17:867–873

    PubMed  Google Scholar 

  13. Katz DM, Trobe JD, Cornbluth WT, Kline LB (1994) Ischemic optic neuropathy after lumbar spine surgery. Arch Ophthalmol 112:925–931

    PubMed  Google Scholar 

  14. Khambatta HJ, Stone JG, Matteo RS et al (1978) Hypotensive anesthesia for spinal fusion with sodium nitroprusside. Spine 3:171

    PubMed  Google Scholar 

  15. Kien ND, Moore PG, Jaffe RS (1992) Cardiovascular function during induced hypotension by fenoldopam or sodium nitroprusside in anesthetized dogs. Anesth Analg 74:72

    PubMed  Google Scholar 

  16. Lam AM, Gelb AW (1983) Cardiovascular effects of isoflurane-induced hypotension for cerebral aneurysm surgery. Anesth Analg 62:742

    PubMed  Google Scholar 

  17. Lee TC, Buerkle H, Wang CJ et al (2001) Effect of isoflurane versus nicardipine on blood flow of lumbar paraspinal muscles during controlled hypotension for spinal surgery. Spine 26:105–109

    Article  PubMed  Google Scholar 

  18. Leigh JM (1975) The history of controlled hypotension. Br J Anaesth 47: 745

    PubMed  Google Scholar 

  19. Malcolm-Smith NA, McMaster MJ (1983) The use of induced hypotension to control bleeding during posterior fusion for scoliosis. J Bone Joint Surg Br 65:255–258

    PubMed  Google Scholar 

  20. Mandel RJ, Brown MD, McCullough NC et al (1981) Hypotensive anesthesia and autotransfusion in spinal surgery. Clin Orthop 154:27

    PubMed  Google Scholar 

  21. Moraca RJ, Sheldon DG, Thirlby RC (2003) The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 238:663–673

    Article  PubMed  Google Scholar 

  22. Murphy MA (2003) Bilateral posterior ischemic optic neuropathy after lumbar spine surgery. Ophthalmology 110:1454–1457

    Article  PubMed  Google Scholar 

  23. Nehls DG, Todd MM, Spetzler RF et al (1987) A comparison of the cerebral protective effects of isoflurane and barbiturates during temporary focal ischemia in primates. Anesthesiology 66: 453

    PubMed  Google Scholar 

  24. Patel NJ, Patel BS, Paskin S, Laufer S (1985) Induced moderate hypotensive anesthesia for spinal fusion and Harrington-rod instrumentation. J Bone Joint Surg Am 67:1384

    PubMed  Google Scholar 

  25. Peterson DO, Drummond JC, Todd MM (1986) Effects of halothane, enflurane, isoflurane, and nitrous oxide on somatosensory evoked potentials in humans. Anesthesiology 65:35–40

    PubMed  Google Scholar 

  26. Shaftan GW, Chiu C, Dennis C, Harris B (1965) Fundamentals of physiologic control of arterial hemorrhage. Surgery 58:851–856

    PubMed  Google Scholar 

  27. Tobias JD (2000) Fenoldopam for controlled hypotension during spinal fusion in children and adolescents. Paediatr Anaesth 10:261–266

    Article  PubMed  Google Scholar 

  28. Wolfe SW, Lospinuso MF, Burke SW (1992) Unilateral blindness as a complication of patient positioning for spinal surgery. Spine 17:600

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma Anesthesiology, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 South Greene St, Baltimore, MD, 21201, USA

    Richard P. Dutton

  2. Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Richard P. Dutton

Authors
  1. Richard P. Dutton
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Iris South Teaching Hospitals, 142 Rue Marconi, 1190, Brussels, Belgium

    Marek Szpalski

  2. Dept. of Anesthesia & Staff Cardiovascular Research Inst., University of California, 94143-0648, San Francisco, USA

    Richard B. Weiskopf

  3. Centenary Clinic, Harmoniestraat 68, 2018, Antwerp, Belgium

    Robert Gunzburg

  4. Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Stauffacherstr. 78, 3014, Bern, Switzerland

    Max Aebi

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Dutton, R.P. (2005). Controlled hypotension for spinal surgery. In: Szpalski, M., Weiskopf, R.B., Gunzburg, R., Aebi, M. (eds) Haemostasis in Spine Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27394-8_11

Download citation

  • DOI: https://doi.org/10.1007/3-540-27394-8_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-24234-5

  • Online ISBN: 978-3-540-27394-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation