Type of anesthesia for lumbar spine surgery in prone position
DOI:
https://doi.org/10.15674/0030-59872019437-41Keywords:
spine surgery, anesthesia, hemodynamics, blood loss, intraocular pressureAbstract
Lumbar spine surgery may be performed under general or spinal anesthesia. There are no criteria for choosing of anesthesia type for such surgery. Objective: to justify the tepe of anesthesia for lumbar spine surgery in prone position. Methods: 254 patients with degenerative lumbar spine diseases ASA I–II were prospectively enrolled to the study. Patients of the spinal anesthesia group (n = 144) were operated under spinal anesthesia, patients of the TIVA group were operated under total intravenous anesthesia. We evaluated the hemodynamics, blood loss, intraocular pressure (IOP) in supine position before and immediately after surgery. Control group was formed by healthy volunteers in whom intraocular pressure was measured before and immediately after lying in the prone position during 90 minutes. Results: turning of non-anesthetized patients into prone position led to decreasing of stoke volume by 25.5 %. We compared these data with intraoperative requirements for sympathomimetics and we could work out the prognostic index of hemodynamic instability (PIHI). In patients with PIHI ≥ 0.5 the risk of intraoperative hemodynamic instability under spinal anesthesia was high. Blood loss in patients with controlled hypotension (mean blood pressure 60–80 mm Hg) did not differ between the groups. Surgery time was significantly higher in TIVA group. Intraocular pressure in prone position was higher, than in supine position. The most significantly IOP increased in TIVA patients on the turned head side. IOP in SA patients did not differ from healthy volunteers. Conclusions: before surgery in prone position it is helpful to evaluate hemodynamic reactions for the body position changes. In cases of PIHI ≥ 0.5 it is better to choose general anesthesia. Type of anesthesia does not influence on the blood loss if controlled hypotension is used. IOP increases significantly in prone position under TIVA.References
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