Type of anesthesia for lumbar spine surgery in prone position

Aim: In case of surgeries done in prone position, patients are rolled to supine during extubation which is associated with loss of monitoring and hemodynamic change. Also, incidence of coughing and bucking are noted. Several studies have shown that prone position extubation is associated with reduced frequency of coughing and monitor disconnection in prone position surgeries. The purpose of this study was to compare the safety and efficacy of patients extubated in prone and supine posted for lumbar spine surgery. Study Design: 60 patients varying from age 18 - 65 years and posted for lumbar spine surgery under general anaesthesia in prone position were randomly allocated to any one of the two groups Group P - In this group extubation was done in prone position at the end of surgery or Group S – In this group extubation was done in supine position at the end of surgery. Place and Duration of Study: Jawaharlal Nehru Medical College, DMIMS (DU), Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha over the period of 1 year (2019 - 2020). Methods: A double blinded randomized controlled comparative study was conducted on 60 patients with primary objective to measure incidence of coughing and severity of coughing in prone vs supine extubation. Patients were anesthetized with fentanyl, nitrous oxide, sevoflurane, and vecuronium. Neuromuscular blockade was reversed in prone position and all patients had spontaneous ventilation at the conclusion of surgery. At time 0, patients were randomly divided into group P or group S. Patients in the group S were then rolled over, while those in the prone position remained undisturbed. Frequency of cough, monitor disconnection and changes in heart rate (HR) and mean arterial pressure (MAP) were noted during extubation. Patient were extubated on purposeful behaviour and eye opening. Results: Frequency of coughing was significantly less in prone patients in comparison to supine group (6 vs. 24 coughs) monitor disconnections dysconnectivity was also fewer (p < 0.001), little change in haemodynamics was noted during extubation. Time to extubation from time 0 was comparatively more in Group S. Airway rescue was not needed. Conclusions: Extubation in prone position is associated with lesser frequency of coughing, disruption of monitors and significantly less hemodynamic changes as compared to supine position extubation he abstract should be concise and informative. It should not exceed 300 words in length. It should briefly describe the purpose of the work, techniques and methods used, major findings with important data and conclusions. Different sub-sections, as given below, should be used. No references should be cited in this part. Generally non-standard abbreviations should not be used, if necessary they should be clearly defined in the abstract, at first use.

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Lumbar spine surgery positioning complications: a systematic review

Neurosurgical FOCUS ◽

10.3171/2015.7.focus15268 ◽

2015 ◽

Vol 39 (4) ◽

pp. E16 ◽

Cited By ~ 23

Author(s):

Michael F. Shriver ◽

Valerie Zeer ◽

Vincent J. Alentado ◽

Thomas E. Mroz ◽

Edward C. Benzel ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Prone Position ◽

Spine Surgery ◽

Web Of Science ◽

Lumbar Spine Surgery ◽

Evidence Based ◽

Inclusion Criteria ◽

Lateral Decubitus ◽

Intraoperative Positioning

OBJECT There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique complications that result from excessive pressure applied to the torso or extremities. The authors reviewed clinical studies reporting complications that arose from positioning of the patient during dorsal exposures of the lumbar spine. METHODS MEDLINE, Scopus, and Web of Science database searches were performed to find clinical studies reporting complications associated with positioning during lumbar spine surgery. For articles meeting inclusion criteria, the following information was obtained: publication year, study design, sample size, age, operative time, type of surgery, surgical position, frame or table type, complications associated with positioning, time to first observed complication, long-term outcomes, and evidence-based recommendations for complication avoidance. RESULTS Of 3898 articles retrieved from MEDLINE, Scopus, and Web of Science, 34 met inclusion criteria. Twenty-four studies reported complications associated with use of the prone position, and 7 studies investigated complications after knee-chest positioning. Complications associated with the knee-elbow, lateral decubitus, and supine positions were each reported by a single study. Vision loss was the most commonly reported complication for both prone and knee-chest positioning. Several other complications were reported, including conjunctival swelling, Ischemic orbital compartment syndrome, nerve palsies, thromboembolic complications, pressure sores, lower extremity compartment syndrome, and shoulder dislocation, highlighting the assortment of possible complications following different surgical positions. For prone-position studies, there was a relationship between increased operation time and position complications. Only 3 prone-position studies reported complications following procedures of less than 120 minutes, 7 studies reported complications following mean operative times of 121–240 minutes, and 9 additional studies reported complications following mean operative times greater than 240 minutes. This relationship was not observed for knee-chest and other surgical positions. CONCLUSIONS This work presents a systematic review of positioning-related complications following prone, knee-chest, and other positions used for lumbar spine surgery. Numerous evidence-based recommendations for avoidance of these potentially severe complications associated with intraoperative positioning are discussed. This investigation may serve as a framework to educate the surgical team and decrease rates of intraoperative positioning complications.

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