Total Intravenous Anesthesia And Spine Neurosurgery - amazonia.fiocruz.br

Total Intravenous Anesthesia And Spine Neurosurgery Video

D Total Intravenous Anesthesia And Spine Neurosurgery widespread attention to the hazards of opioid agents, opioid misuse remains a leading cause of accidental death in the US. There are multiple opportunities for the anesthesiologist, surgeon, and institution to reduce opioid exposure and minimize patient harm. MMA has been consistently demonstrated to minimize opioid consumption and related side effects and is considered a vital component of ERAS pathways. Opioid-free anesthesia OFA has recently been receiving interest as a potential strategy to fill this knowledge gap.

Initially pioneered for bariatric surgery, the technique relies on combinations of nonopioid agents and adjuncts, including propofol, dexmedetomidine, lidocaine, magnesium, and ketamine to produce anesthesia, sympatholysis, and analgesia. Results from case reports and prospective studies are accumulating to support OFA as a tool that offers the following: 1 equivalent intraoperative anesthetic conditions compared to opioid-containing regimens, 319 2 improved postoperative analgesia with opioid-sparing effects, 1719 3 shorter https://amazonia.fiocruz.br/scdp/essay/media-request-css/japan-and-the-benefits-of-nuclear-energy.php of postanesthesia care unit PACU length of stay LOS8 4 reduced postoperative nausea and Anesthesiq PONV40 and 5 higher patient satisfaction.

To date, there are no comprehensive reports of OFA for spine surgery. However, 2 case reports in multilevel spine fusion suggest the technique may be feasible. We performed a retrospective, nested comparison of OFA to our standard opioid-containing anesthetic regimen within an ERAS pathway for minimally invasive lumbar decompression. An of the cohort received OFA. We report a significant opioid-sparing effect when using OFA without differences in Ahd control or postoperative opioid consumption. When used with comprehensive multimodal analgesia within an ERAS pathway of care for lumbar decompression, OFA is a feasible method for protecting patients from potential unnecessary opioid exposure.

The study was carried out with institutional IRB Total Intravenous Anesthesia And Spine Neurosurgery. We included 36 patients presenting for surgery between February and August Eighteen patients underwent surgery in which an OFA technique was used. A matched cohort of 18 patients underwent surgery in which an opioid-containing anesthesia OCA technique was used.

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All patients were cared for under an ERAS pathway for lumbar decompression, as described previously. Patients were given oral acetaminophen mg and gabapentin mg in the preoperative holding area, provided they had no contraindications. General anesthesia was administered via endotracheal intubation.

On arrival to the operating room, standard ASA monitors were applied electrocardiography, noninvasive blood pressure monitor, and pulse oximetryand premedication was provided midazolam 0. All patients received propofol 1. Inhaled halogenated agents isoflurane or sevoflurane were permitted, up to 0.

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Dual antiemetic therapy with dexamethasone 4 or 8 mg and ondansetron 4 mg were provided. Ketorolac 15 or 30 mg, according to age and weight was given during surgical closure. Residual neuromuscular blockade was reversed with glycopyrrolate and neostigmine after assessment of neuromuscular function with train-of-four monitoring.

Blood pressure was Anesthesiia noninvasively every 5 minutes throughout the procedure, and heart rate was recorded continuously. All procedures were performed by a single surgeon S. After induction of general anesthesia, patients were positioned prone on a radiolucent table with Wilson frame. In the event that there were concerns regarding the accuracy of the 3D navigation intraoperatively, traditional fluoroscopic MIS techniques were utilized. A paravertebral incision was made, extending between the cephalad and caudad pedicles on the symptomatic side. Working through the paravertebral incision, soft-tissue dilators were sequentially introduced to allow an mm tubular retractor to be docked at the lamina overlying the pathological disc level.]