Difference between revisions of "Lumbar Laminectomy"
From WikiAnesthesia
(New page for Lumbar lami) |
|||
| Line 2: | Line 2: | ||
| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = PIV, +/ | | lines_access = PIV, +/- A-line | ||
| monitors = Standard, +/- A-line | | monitors = Standard, +/- A-line, +/- BIS/Massimo if TIVA | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning | | considerations_intraoperative = Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning | ||
| Line 55: | Line 55: | ||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
CBC, Coags | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
TIVA if neurophysiological monitoring | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
| Line 65: | Line 67: | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
Large bore IV access. Potential for large volume blood loss | Large bore IV access. Potential for large volume blood loss during exposure | ||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
| Line 95: | Line 97: | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Prone positioning | |||
* Minimize large volume of crystalloid | |||
** Ischemic neuropathy | |||
** Airway edema | |||
** Consider blood or albumin for intravascular expansion | |||
* Pad pressure points | |||
** Check eyes and ears | |||
** Foam pillow with cutouts for eyes, nose mouth, | |||
** Typically arms abducted & limit flexion to <90* | |||
** Pad elbows knees, feet, arms | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Latest revision as of 11:54, 30 March 2023
Lumbar Laminectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV, +/- A-line |
| Monitors |
Standard, +/- A-line, +/- BIS/Massimo if TIVA |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning |
| Postoperative |
Pain control |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Lunar laminectomy is a complete removal of lamina, which is use for to decompress the neural elements of the lumbar spine, usually via a posterior approach in the prone position.
Overview
Indications
Lumbar radiculopathy 2° degenerative disc disease from herniated disks, congenital stenosis, neoplasm, and, occasionally, trauma. Lumbar laminectomy is also used to gain access to the spinal canal for dealing with intradural tumors, arteriovenous malformations (AVMs), and other spinal cord lesions.
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
CBC, Coags
Operating room setup
TIVA if neurophysiological monitoring
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Large bore IV access. Potential for large volume blood loss during exposure
Induction and airway management
Standard induction
Avoid long acting paralytic if neurophysiological monitoring. Consider succinylcholine or remifentanil bolus (1.5mg/kg)
Positioning
Prone positioning
Maintenance and surgical considerations
1-2 hour for single level
+0.5-1hr per additional level
TIVA if neurophysiological monitoring (Propofol, Remi, phenylephrine to support BP)
BIS or Massimo to monitor depth of anesthesia if using TIVA
Avoid large volume resuscitation given prone positioning
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Prone positioning
- Minimize large volume of crystalloid
- Ischemic neuropathy
- Airway edema
- Consider blood or albumin for intravascular expansion
- Pad pressure points
- Check eyes and ears
- Foam pillow with cutouts for eyes, nose mouth,
- Typically arms abducted & limit flexion to <90*
- Pad elbows knees, feet, arms
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |