Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center Volume 3 - Issue 5

João Abrão¹, Álvaro Dowling², Jorge Felipe Ramírez León³ and Kai-Uwe Lewandrowski⁴*

• ^{1Professor of Anesthesiology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil}
• ²MDFundación Universitaria Sanitas, Bogotá, Colombia, Research Team, Centro de Columna. Bogotá, Colombia, Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
• ³Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Chile
• ⁴Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, USA

Received: September 21, 2020;  Published:October 20, 2020

Corresponding author: Kai-Uwe Lewandrowski, MD, Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson AZ, USA

DOI: 10.32474/GJAPM.2020.03.000174

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Abstract

Background: Providing adequate anesthesia that caters to rapid turn-over in an outpatient ambulatory surgery center setting is sometimes as much of an art as it is a science. Outpatient spine surgery is characterized by shorter simplified versions of their inpatient counterparts carried out in a hospital setting.

Objective: The monitored anesthesia care (MAC) and deep sedation with a laryngeal mask airway (LMA) in the prone position have received little attention in the anesthesia and spine surgery literature. The authors reviewed their clinical outcomes with the outpatient endoscopic spinal surgery in conjunction with these two types of anesthesias.

Methods: We performed an analysis of perioperative anesthesia and clinical outcomes in 184 patients who underwent lumbar endoscopic spinal surgery in two outpatient ambulatory surgery centers. The 184 patients consisted of 90 (48.9%) women and 94 (51.1%) men with an average age of 54.3 ± 15.4 years. The average follow-up of 43.27 months. The primary clinical outcome measures were the modified Macnab criteria. Chi-square testing was employed to analyze statistically significant associations between the type of anesthesia, preoperative diagnosis, the surgical level(s), and surgeon requirements for MAC versus balanced general anesthesia.

Results: At the final follow-up, the majority of patients had Excellent (93/184; 50.5%) and Good (74/184; 40.2%) Macnab outcomes regardless of treatment and anesthesia. There was minimal blood loss in all patients, and there were no complications such as dural tears, or hematomas. There were also no wound problems such as bleeding, or leaking of endoscopic irrigation fluid from the wound. Of the 184 study patients, 40 patients (21.7%) had a postoperative irritation of the dorsal root ganglion (DRG). The mean anesthesia time was 37 ± 9 minutes in patients under balanced general anesthesia. with LMA and 48 ± 12 minutes in MAC patients. All of the 184 patients were discharged under one hour from the PACU after an uneventful wakeup. Only six patients (3.26%) had postoperative nausea.

Conclusions: Monitored anesthesia care with sedation in an ambulatory surgery center in the prone position is best suited for endoscopic spinal decompressions. Intubation of the patient with general anesthesia is generally not required. Most patients can be managed with a nasal cannula, face mask, or a balanced general anesthesia with a laryngeal mask airway (LMA).

Keywords: Lumbar endoscopic decompression surgery; anesthesia management; clinical outcomes

Abbreviations: MAC: Monitored Anesthesia Care; LMA: Laryngeal Mask Airway; MISS: Minimally Invasive Spine Surgery; ASC: Ambulatory Surgery Center

Abstract| Introduction| Materials and Methods| Endoscopic Surgical Technique| Clinical Follow-Up| Correlative Surgical Outcomes Analysis| Result| Discussion| Conclusion| Conflicts of Interest| Disclaimer| Conflicts| References|