Anterior cervical spine surgery

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
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Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System	Considerations
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.
Respiratory	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

Intraoperative management

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.

Postoperative 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