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