Spinal Surgery
Time: Variable
Pain: Variable, but may be severe (especially with scoliosis fixation)
Position: Typically prone, though anterior (supine) and lateral approaches may be used
Blood loss: May be substantial in multi-level operations
Special Drugs
Spinal surgery is generally performed under GA, but may use epidural for post-operative analgesia, especially in scoliosis operations. Anaesthetic considerations vary depending on the operation:
| Operation | Time |
|---|---|
| Microdisectomy | 1-2 hours |
| Cervical discectomy | 2 hours |
| Spinal fusion | 1+1 per level |
| Cervical fusion | 3 hours |
| Tumour | 2-6+ hours |
| Scoliosis corection | 3-6+ hours |
| Fracture fixation | 2-6 hours |
Considerations
May be highly variable, and depending on the position, number of levels, and the patient. Important factors:
- A
- Must be secured in prone position
- Consider use of a reinforced tube with a bite block to prevent kinking and occlusion
- Risk of cord oedema and inability to extubate after a long case
- B
- Test ventilatiojn once positioned
- C
- Secure venous access is vital
- MVE with 3-way tap recommended if cannula is not accessible
- D
- Analgesia requirements vary widely and may be substantial
- E
- Active warming and temperature montioring is required
- Risk of pressure area and nerve injury
- Breasts and genitals
- Face
- Upper limbs
Especially if arms are above the head, which puts traction on the brachial plexus.
- H
- Blood loss may be substantial