Anterior cervical spine surgery
From WikiAnesthesia
Revision as of 16:46, 22 June 2022 by WikiAnesthesia (talk | contribs)
Anterior cervical spine surgery
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV, possible arterial line |
| Monitors |
Standard, possible invasive BP monitoring, possible neuromonitoring |
| Primary anesthetic considerations | |
| Preoperative |
Neck ROM, preoperative neurologic exam |
| Intraoperative |
TIVA for neuromonitoring |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary here.
Overview
Indications
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Potentially limited neck ROM related to pain, trauma, or mechanical stabilization devices leading to more challenging airway. Potential unstable cervical spine, instrumentation could cause permanent paralysis. Consider awake intubation if high concern for unstable spine or difficult airway. |
| Neurologic | Possible preexisting motor and/or sensory deficits, particularly in the upper extremities. These symptoms may be exacerbated by head/neck positioning. May have chronic pain. |
| Cardiovascular | Intraoperative bradycardia related to traction on the carotid bulb. |
| Pulmonary | Limited neck ROM related to pain or structural changes can cause difficult laryngoscopy. Recurrent laryngeal nerve potentially at risk of damage intraop. |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Potentially limited neck ROM related to pain, trauma, or mechanical stabilization devices leading to more challenging airway. Potential unstable cervical spine, instrumentation could cause permanent paralysis. Consider awake intubation if high concern for unstable spine or difficult airway. Consider neuro exam following awake intubation if concern for cervical spine injury.
Positioning
Positioned supine, typically on a doughnut gel pillow to facilitate neck positioning.
Maintenance and surgical considerations
- Neuromonitoring may be used to detect potential nerve/spinal cord injury. In these cases, surgical teams typically require no paralytic and frequently request TIVA techniques to minimize the affect of anesthetic on neuromonitoring.
Emergence
Postoperative management
Disposition
Pain management
Potential complications
- Neck hematoma
- Airway edema
- Injury to cranial nerves, recurrent laryngeal nerve, and/or superior laryngeal nerve
- Dural tear
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |