Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery

OBJECTIVE Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation. METHODS Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review. Cases were divided into nonfusion and fusion procedure categories and analyzed for demographics and baseline medical status; pre-, intra-, and postoperative events; hospital course, including Acute Pain Service (APS) consults; and follow-up visit outcome data. RESULTS A total of 345 consecutive lumbar spine procedures were found, with 343 records complete for analysis, including 181 fusion and 162 nonfusion procedures and spinal levels from T11 through S1. The fusion group was significantly older (mean age 65.9 ± 12.4 vs 59.5 ± 15.4 years, p < 0.001) and had a significantly higher proportion of patients with American Society of Anesthesiologists (ASA) Physical Status Classification class III (p = 0.009) than the nonfusion group. There were no intraoperative conversions to GA, with infrequent need for a second dose of SA preoperatively (2.9%, 10/343) and rare preoperative conversion to GA (0.6%, 2/343) across fusion and nonfusion groups. Rates of complications during hospitalization were comparable to those seen in the literature. The APS was consulted for 2.9% (10/343) of procedures. An algorithm for the integration of SA into a lumbar spine surgery practice, from surgical and anesthetic perspectives, is also offered. CONCLUSIONS SA is a viable, safe, and effective option for lumbar spine surgery across a wide range of age and health statuses, particularly in older patients and those who want to avoid GA. The authors’ protocol, based in part on the largest set of data currently available describing complex instrumented fusion surgeries of the lumbar spine completed under SA, presents guidance and best practices to integrate SA into contemporary lumbar spine practices.

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Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience

PLoS ONE ◽

10.1371/journal.pone.0217939 ◽

2019 ◽

Vol 14 (6) ◽

pp. e0217939 ◽

Cited By ~ 2

Author(s):

Hao Deng ◽

Jean-Valery Coumans ◽

Richard Anderson ◽

Timothy T. Houle ◽

Robert A. Peterfreund

Keyword(s):

Lumbar Spine ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Single Center ◽

Vasoactive Agents ◽

Single Center Experience ◽

Frequent Use

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Experiences of spinal anesthesia for previous lumbar spine surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-200706001-00364 ◽

2007 ◽

Vol 24 (Supplement 39) ◽

pp. 99

Author(s):

S. Kim ◽

S J. Lee ◽

J H. Kim ◽

Y S. Shin

Keyword(s):

Lumbar Spine ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Lumbar Spine Surgery

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Analysis of Risk Factors Associated with Hospital Readmission Within 360 Days After Degenerative Lumbar Spine Surgery in Elderly Patients

World Neurosurgery ◽

10.1016/j.wneu.2019.01.293 ◽

2019 ◽

Vol 126 ◽

pp. e196-e207 ◽

Cited By ~ 2

Author(s):

Jong Joo Lee ◽

Seong Bae An ◽

Tae Woo Kim ◽

Dong Ah Shin ◽

Seong Yi ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Elderly Patients ◽

Spine Surgery ◽

Hospital Readmission ◽

Lumbar Spine Surgery ◽

Factors Associated ◽

Degenerative Lumbar Spine ◽

Surgery In Elderly

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176 Efficiency of Spinal Anesthesia in Comparison to General Anesthesia in Lumbar Spine Surgery: A Retrospective Analysis of 544 Patients

Neurosurgery ◽

10.1093/neuros/nyx417.176 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 245-246

Author(s):

John Thomas Pierce ◽

Prateek Agarwal ◽

Paul J Marcotte ◽

William Charles Welch

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Hospital Stay ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Lumbar Spine Surgery ◽

Anesthesia Time

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

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Anesthesia Analepsia Management Improves Postoperative Stress Reaction and Oxygenation in Elderly Patients Undergoing Lumbar Spine Surgery

10.21203/rs.3.rs-534726/v1 ◽

2021 ◽

Author(s):

Guifei Li ◽

Zhi Chen ◽

Furong Tan ◽

Qiang Huang ◽

Yizhen Li ◽

...

Keyword(s):

Lumbar Spine ◽

Elderly Patients ◽

Spine Surgery ◽

Management Strategy ◽

Test Group ◽

Stress Reaction ◽

Controlled Study ◽

Lumbar Spine Surgery ◽

Control Group ◽

Postoperative Stress

Abstract Background: Developing a scientific and effective anesthesia analepsia management strategy is of great significance to reduce the risk of complications in elderly patients. This study aims to explore the effect of analepsia management on the postoperative stress reaction and oxygenation in elderly patients with lumbar spine surgery.Methods: In this randomized controlled study, 60 elderly patients who underwent lumbar spine surgery with general anesthesia in Traditional Chinese Medicine Hospital of Shapingba District, Chongqing City were included. According to the random number table method, patients were randomly divided into test group (n=30) and control group (n=30). During the analepsia period, patients in the control group received routine management, while the test group received a new analepsia management strategy based on the control group. The analepsia quality, postoperative stress reaction, oxygenation function, and complication rates of the two groups were compared.Results: Compared with the control group, the extubation time, fully awake time, and resuscitation chamber residence time in test group were significantly shortened (P<0.05). At different times postoperatively, the test group had significantly lower epinephrine, cortisol, and blood sugar levels than the control group (P<0.001), and significantly higher or lower PaO2, oxygenation index (OI), and PaCO2 values (P<0.01). Compared with the control group, the postoperative visual analogue scale (VAS) score in the test group was lower (P＜0.05), while the Quality of Recovery-40 (QoR-40) score was higher (P＜0.05), and the test group had a lower incidence of restlessness, hypothermia and respiratory complications during the analepsia period (P<0.05).Conclusions: This study showed that the analepsia management strategy could improve the postoperative stress reaction and oxygenation function of elderly patients with lumbar spine surgery, which could promote the postoperative recovery of patients.

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INFLUENCE OF ANESTHESIA TYPE ON INTRAOCULAR PRESSURE DURING SPINE SURGERY IN PRONE POSITION

Wiadomości Lekarskie ◽

10.36740/wlek202001120 ◽

2020 ◽

Vol 73 (1) ◽

pp. 104-106

Author(s):

Mykola V. Lyzohub ◽

Marine A. Georgiyants ◽

Kseniia I. Lyzohub ◽

Juliia V. Volkova ◽

Dmytro V. Dmytriiev ◽

...

Keyword(s):

Intraocular Pressure ◽

Lumbar Spine ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Head Rotation ◽

Lumbar Spine Surgery ◽

Intravenous Anesthesia ◽

Group I ◽

Before And After ◽

Spinal Segments

The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) – under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) – under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

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