EXPERTS’ OPINION   Free access

Minerva Anestesiologica 2022 May;88(5):396-406

DOI: 10.23736/S0375-9393.22.15933-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Perioperative management in complex spine surgery

Michael SINGLETON ^{1, 2}, Daniela GHISI ³ ✉, Stavros MEMTSOUDIS ^{1, 2, 4}

¹ Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA; ² Weill Cornell Medical College, Department of Anesthesiology, New York, NY, USA; ³ Unit of Anesthesia, Intensive Care and Pain Therapy, Rizzoli Orthopedic Institute, Bologna, Italy; ⁴ Weill Cornell Medical College, Division of Epidemiology, Department of Public Health, New York, NY, USA

The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multilevel spinal arthrodesis and osteotomies. Moreover, different surgical approaches are described at different spine levels: the anesthesiologist should be aware of the potential benefits and risks for the patients and be prepared for their management. In this narrative review we seek to describe basic concepts of perioperative spine care and address evolving areas in which care is changing. We will discuss preoperative concerns, intraoperative management including airway management, choice of maintenance, intraoperative neuromonitoring and anesthetic effect, blood management and the dynamic topic of anesthetic and analgesic techniques. Finally, we will briefly address the issue of perioperative complications as they relate specifically to spine surgery.

KEY WORDS: Spine; Preoperative care; Postoperative complications