• dexmedetomidine
• minimally invasive spine surgery
• monitored anesthesia care

• Humans
• Retrospective Studies
• Bradycardia/chemically induced
• Dexmedetomidine/therapeutic use
• Anesthesia, General
• Hypnotics and Sedatives/therapeutic use
• Hypotension

• anterior cervical discectomy and fusion (acdf)
• lumbar discectomy
• lumbar-fusion
• spine surgery anesthesia
• surgical case volume

• In-hospital mortality
• Postoperative respiratory failure
• Preoperative counseling
• Prolonged intubation
• Spinal metastasis
• Unplanned intubation

• Male
• Humans
• Adult
• Middle Aged
• Aged
• Hospital Mortality
• Retrospective Studies
• Spinal Neoplasms/complications
• Risk Factors
• Postoperative Complications/etiology
• Respiratory Insufficiency

• Humans
• Airway Extubation
• Cough
• Heart Rate/physiology
• Hemodynamics/physiology
• Prone Position/physiology

• Airway management
• Distraction
• Neuromonitoring
• Scoliosis
• Spinal cord injuries

Background

The analgesic efficacy of preemptive administration of caudal morphine for spine surgeries in adults is not well studied. In a double-blinded, randomized controlled trial, safety and analgesic efficacy of preemptive, single-shot caudal morphine and bupivacaine was compared with caudal bupivacaine alone in lumbosacral spine surgeries.

Methods

After Institutional Ethics Committee approval, 40 patients aged 18-60 yrs planned for lumbosacral spine surgery were randomized to groups of 20 patients each. After induction and prone positioning, an ultrasound-guided caudal block was performed with morphine 50 µg/kg with 20 ml 0.25% bupivacaine in the study group (LM) and only bupivacaine in the control group (LA). Postoperatively, both groups received intravenous morphine via patient-controlled analgesia (PCA) pump (No basal, 1 mg/bolus, 10 minutes lockout interval). Intraoperative fentanyl use, postoperative 24-h morphine consumption, visual analogue pain scores (VAS) and adverse effects of morphine were noted.

Results

Demographics and baseline data were comparable. Postoperative 24-hour morphine requirement was more in LA group (34.3 ± 10.7 mg vs 19.65 ± 11.8 mg, p=0.0001). Total intraoperative supplemental fentanyl requirement was similar (79.25 ± 67.60 µg in LA vs 54 ± 50.20 µg in LM group, p=0.28). VAS scores at 2/4/6/12-hour in group-LM were significantly less than group-LA (p=0.005, 0.002, 0.001 and 0.047) but were comparable at 18 and 24 hours (p=0.25, 0.42). Postoperative incidence of adverse effects of morphine was comparable.

Conclusions

Ultrasound-guided, single-shot preemptive administration of caudal morphine with bupivacaine is a safe and effective modality of analgesia for patients undergoing lumbosacral spine surgeries.

• Blood loss
• Cervical vertebrae
• Hemostasis
• Hemostatics/therapeutic use
• Lumbar vertebrae
• Spine surgery

• cerebral palsy
• drug resistance
• rocuronium
• skeletal muscle

• U54 GM104941 NIGMS NIH HHS

• Intra-abdominal pressure
• pressure-controlled ventilation
• prone position
• volume-controlled ventilation

Pott's disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60% of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.

• Anesthesia
• perioperative concerns
• spinal tuberculosis

• Anesthesia intravenous
• Dexmedetomidine
• Evoked potentials
• Neurophysiological monitoring
• Spinal fusion

• Anestesia
• Anesthesia
• Cirugía
• Intraoperative neurophysiological monitoring
• Monitorización neurofisiológica intraoperatoria
• Surgery
• anestesia general
• anestesia intravenosa
• general anaesthesia
• intravenous anaesthesia
• neurosurgical procedures
• procedimientos neuroquirúrgicos

• Anesthetics
• Consensus
• Intraoperative Neurophysiological Monitoring
• Neurosurgical Procedures/adverse effects

• Analgesics
• Opiates
• Opioids
• Postoperative
• Spine surgery

• cell salvage
• scoliosis
• spinal surgery
• tranexamic acid
• transfusion

• TIVA
• desflurane
• propofol
• remifentanil
• scoliosis
• somatosensory evoked potential

• Epigenetics of pain
• ketamine
• liposomal bupivacaine
• multimodal opioid
• pathophysiology
• spinal surgery.

• General anesthesia
• High-risk patients
• Lumbar surgery
• Spinal anesthesia

Regional analgesic techniques are difficult to use in tubercular spine patients due to distorted spinal anatomy and presence of infection. This study was conducted with the aim to evaluate analgesic efficacy of local wound infiltration before wound closure in tubercular spine patients.

This pilot randomised double-blind controlled study was conducted in 32 American Society of Anesthesiologists I-III patients, age ≥15 years, undergoing elective surgery for spinal tuberculosis. All the patients received general anaesthesia using standard technique and intravenous morphine for intraoperative analgesia. They received wound infiltration with either normal saline (group C) or local infiltration analgesia with 0.375% ropivacaine 3 mg/kg, adrenaline 5 μg/mL and dexmedetomidine 1 μg/kg in a total volume of 0.8 mL/kg (group LIA) before wound closure. Patient-controlled analgesia using intravenous morphine provided postoperative analgesia. The primary objective was to study 24-h morphine consumption, whereas the secondary objectives included pain scores, complications and patient satisfaction. Repeated measures analysis of variance, Chi-square test and Mann–Whitney U test were used for statistical analysis.

Morphine requirement was lower in group LIA (6.7 ± 2.7 mg) than in group C (27.7 ± 7.9 mg);P < 0.001. Group LIA also had lower pain scores (P < 0.001), longer time to rescue analgesic (P < 0.001), better patient satisfaction to pain relief (P = 0.001) and lower incidence of postoperative nausea and vomiting than group C.

Wound infiltration with ropivacaine, adrenaline and dexmedetomidine before wound closure provided good postoperative analgesia with lower morphine requirement.

• Dexmedetomidine
• postoperative analgesia
• ropivacaine
• spinal tuberculosis
• wound infiltration

• PearlDiver
• complications
• gender
• posterior lumbar fusion
• retrospective
• rhbmp2

Desflurane and sevoflurane are inhalational anesthetics which provide stable intraoperative hemodynamics and rapid emergence from anesthesia. Dexmedetomidine is an α2-agonist with sedative and hypnotic effects. We compared recovery following anesthesia with a combination of a continuous intravenous infusion of dexmedetomidine and desflurane or sevoflurane in cases of spine surgeries because no such data are available from India.

It was a single-blind, prospective, randomized study. After institutional ethics committee approval, patients were randomly allocated to one of the two groups of fifty patients each. Group D received desflurane and Group S received sevoflurane, along with dexmedetomidine 0.5 μg/kg/h IV infusion for maintenance of anesthesia.

Extubation time (ET) in Group D was shorter by 4.2 min than in Group S (10.1 ± 2.2 and 14.2 ± 1.3; P = 0.004). Postoperative recovery, postoperative analgesic, and antiemetic requirement between the groups were comparable The mean dial setting required to maintain the minimum alveolar concentration of 1 intraoperatively was 3.1 for desflurane and 0.7 for sevoflurane.

• Desflurane
• dial setting
• extubation time
• minimum alveolar concentration
• postoperative recovery
• sevoflurane

Several techniques have evolved over time to monitor depth of anesthesia and ensure enhanced recovery. This randomized double-blinded trial was designed to compare bispectral index (BIS) or end-tidal anaesthetic concentration (ETAC) monitoring on the recovery characteristics of patients undergoing thoracolumbar spine surgeries.

Seventy American Society of Anesthesiologist I–II patients of either sex were randomized to Group B – BIS-guided protocol, Group E – ETAC-guided protocol, or Group S – Standard protocol. After intravenous induction, anaesthesia was maintained with desflurane in O₂/N₂O (50:50) mixture. In BIS, ETAC and Standard groups, inspired end-tidal desflurane concentration was varied to achieve BIS of 45–55, 0.8–1.0 age-corrected minimum alveolar concentration, and haemodynamic parameters within 20% of the baseline, respectively. Time to eye opening (emergence time, the primary outcome), time to extubation, and time to name recall from the discontinuation of the anaesthetic agent were recorded. Incidence of nausea, vomiting, and total analgesic consumption was noted for 24 h.

Emergence time (mean ± SD) in ETAC (5.1 ± 1.53 min) and BIS (5.0 ± 2.12 min)-guided groups was significantly lower than Standard group (7.5 ± 2.90 min). Extubation time in ETAC (6.3 ± 2.22 min) and BIS-guided group (6.5 ± 1.78 min) was significantly lower than Standard group (9.0 ± 3.20 min) (P < 0.001). Time to achieve fast track score of more than 12 was significantly less in BIS-guided group (13.12 ± 2.59 min).

ETAC-guided anaesthesia is comparable to BIS-guided anaesthesia in achieving early recovery.

• Bispectral index
• desflurane recovery profile
• end tidal anaesthetic concentration
• lumbar spine surgery

• opioids
• lumbar fusion
• minimally invasive fusion
• low back pain
• comorbidity
• depression
• smoking

• Analgesics, Opioid/adverse effects
• Analgesics, Opioid/therapeutic use
• Humans
• Low Back Pain/drug therapy
• Low Back Pain/surgery
• Lumbosacral Region/surgery
• Opioid-Related Disorders/epidemiology
• Retrospective Studies
• Risk Factors
• Spinal Fusion/adverse effects
• Spinal Fusion/statistics & numerical data

• KL2 TR000072 NCATS NIH HHS
• KL2 TR001441 NCATS NIH HHS
• R01 DA039192 NIDA NIH HHS
• UL1 TR001439 NCATS NIH HHS

A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery.

Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit.

There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF.

SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery.

• Balanced
• fluids
• scoliosis
• surgery

• neurology, spinal
• prehospital care

• Neurotrauma
• Spine fracture
• Traumatic myelopathy

Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer to the intensive care unit (ICU) have not been studied in sufficient detail.

A retrospective case-control study of elective orthopedic surgery patients (knee, hip, shoulder, or spine, n = 51) who developed unanticipated respiratory failure (RF) necessitating transfer to the ICU over a 3-year period was conducted. Controls (n = 153) were frequency matched to cases by gender, age, and surgical procedure. Patient and perioperative care factors, clinical outcomes, and cost of care were examined.

Transfer to the ICU occurred within 48 h of surgery in 73 % of the cases, 31 % required non-invasive ventilation, and 18 % required mechanical ventilation. Cases had a higher prevalence of chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and regular psychotropic medication use than controls. Cases received more intravenous opioids during the first 24 postoperative hours, were hospitalized 4 days longer, had higher in-hospital mortality, and had excess hospitalization costs of US$26,571. COPD, OSA, preoperative psychotropic medications, and anesthesia time were associated with risk of RF in a multivariate analysis.

Unanticipated RF after orthopedic surgery is associated with extended hospitalization, increased mortality, and higher cost of care. Hospital protocols that include risk factor assessment, enhanced monitoring, and a cautious approach to opioid use in high-risk patients may reduce the frequency of this complication.

• Critical care medicine
• In-hospital
• Intensive care unit transfer
• Orthopedic procedure
• Respiratory failure

Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view.

To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.

Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively randomized into two groups of 20. In the first group (study group), 2 mg of morphine sulfate diluted in 10 mL of physiological serum was infiltrated into the epidural space, through the laminectomy area. The second group (controls) did not receive analgesia. The patients were asked about their pain levels before and after the operation, using a visual analog scale (VAS).

It was found that the patients presented a significant diminution of pain as shown by the VAS. From before to after the operation, it decreased by an average of 4.7 points (p = 0.0001), which corresponded to 53.2% (p = 0.0001).

Application of 2 mg of morphine sulfate in a single epidural dose was shown to be a good technique for pain therapy following lumbar spinal surgery.

• Arthrodesis
• Epidural analgesia
• Morphine
• Postoperative pain
• Vertebral fusion

• cell therapy
• clinical translation
• neuroprotection
• neuroregeneration
• spinal cord injury