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 |
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| Editor rating | |
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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 |