Anesthesia Considerations 

Spine Surgery 

 

 

Considerations

 

• Surgical indication (instability, tumour, kyphoscoliosis, decompression/fusion, infection, congenital)

• Potential for difficult airway with C-spine disease

• Risk of blood loss, hypovolemic shock, massive transfusion → perioperative blood conservation strategies

• Potential neurological deficits, spinal cord injury

• Neuromonitoring considerations

• Prone positioning complications:

  • Venous air embolism

  • Nerve injury

  • Postoperative visual loss

  • Airway swelling

• Postoperative pain management

• Patient considerations:

  • Trauma, malignancy, chronic pain, spinal shock, respiratory insufficiency

  • Scoliosis (lung disease, pulmonary hypertension, RV failure)

 

 

Goals & Conflicts

 

• Careful airway assessment & management 

• Perioperative blood conservation:

  • Preoperative: iron, erythropoietin, preoperative autologous donation, correction of coagulopathy

  • Intraoperative: acute normovolemic hemodilution, cell saver, anti-fibrinolytics (tranexamic acid), surgical techniques, anesthetic techniques (patient positioning, normothermia, controlled hypotension)

  • Postoperative: transfusion targets

• Anesthetic technique:

  • Neuromonitoring (TIVA, avoid neuromuscular blocking drugs)

  • Opioid sparing (ketamine, lidocaine, dexmedetomidine)

  • Careful securement of ETT, lines, monitors

• Assessment for airway swelling prior to extubation