The Spine

My current rotation is focused on anesthesia for spine surgeries. Our active neurosurgical and orthopedic groups have a busy service at Stanford. Although spine surgeries are similar to other general anesthetics, they have their own specific anesthetic concerns. Many patients undergo spine surgery because of chronic pain. One of my patients has a pain regimen that would widen the eyes of any practitioner: a daily dose of 600mg of morphine and 100mg of methadone, as well as muscle relaxants. Anesthetizing this patient and selecting opiates to achieve a smooth and comfortable wake-up is a real challenge. Yet after two large vials of sufentanil, a couple vials of dilaudid, a generous dose of ketamine, and some lidocaine, the patient woke up smoothly. Other patients with cervical spine problems can be difficult to intubate, requiring recognition, planning, and facility with advanced airway devices. The spine is quite vascular and spine surgeries (especially tumor resections) can bleed a lot. Because surgery near the spinal cord can lead to changes in neurologic function, spine surgeries are often done with neuromonitoring. We have to understand how our anesthetics change an EEG, EMG, and somatosensory potentials. Lastly, spine surgeries are often done on the back, and having patients on their stomach for hours has its own risks including blindness. So hopefully this month will give me an opportunity to learn and refine anesthesia for this aspect of neurologic surgery.

Image is in the public domain, from Wikipedia.