|
Thoracolumbar region: degenerative disease, spinal stenosis,
trauma |
Major position change |
Prone, lateral, or knee-chest position |
|
Awake intubation and position |
If unstable after trauma and major position change required |
|
Blood loss |
Especially with reoperations, instrumentation, and spinal stenosis;
risk of occult aortoiliac or major venous tear |
|
Air embolism |
Infrequent; perhaps with knee-chest position and Relton-Hall
frames |
|
Postoperative visual loss |
Etiology unclear; associated with long prone procedures, low
hematocrit, large estimated blood loss, and hypotension. Patient variables may contribute
(see "Prone" in the section "Positioning") |
|
Cervical region: degenerative disk disease, stenosis, trauma,
rheumatoid arthritis |
Maintain neutral neck position to avoid cord compression |
Supine/anterior approach for most diskectomies. Posterior approach
(prone or sitting) for laminectomy and occasional diskectomy |
|
Maintain perfusion pressure at waking normal levels |
If existing cord compression or recent cord injury or if cord
retraction required |
|
Hypotension (spinal shock) |
Occurs with complete cervical cord injury |
|
Postoperative respiratory insufficiency |
Occurs with cervical cord injury |
|
Methylprednisolone[338]
[339]
|
30 mg/kg over 1-hr period, then 5.4 mg/kg for 23 hr |
|
Air embolism |
With sitting laminectomies |
|
Anterior cervical diskectomy |
Traction required for anterior graft insertion? |
|
|
Retractor compression of airway |
|
|
Postoperative swelling/airway compression |
|
|
Postoperative cranial nerve dysfunction |
|
|
Cervical instability |
Awake intubation |
Prone or supine |
|
Awake positioning |
|
|
Axial stabilization for intubation |
If awake intubation not feasible |
|
Vertebral metastasis |
Large blood loss |
Prone or anterolateral/retroperitoneal |
|
|
Double-lumen tube for lesions above L1 |
|
Spinal cord tumors |
Maintain perfusion pressure during retraction |
Prone |
|
Methylprednisolone |
|
|
Procedures with major neurologic risk |
Wake-up test |
Prone. Rehearse with patient |
|
Somatosensory evoked responses |
Anesthetic restrictions |
|
Motor evoked responses |
Anesthetic/relaxant restrictions |
|
Pedicle screw electromyogram |
Relaxant restriction |
