Cargando…
Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery
BACKGROUND: With the increase in life expectancy seen throughout the world, the prevalence of degenerative spinal pathology and surgery to treat it has increased. Spinal surgery under general anesthesia leads to various problems and complications, especially in patients with numerous medical comorbi...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982434/ https://www.ncbi.nlm.nih.gov/pubmed/32021410 http://dx.doi.org/10.2147/JPR.S227212 |
_version_ | 1783491309956235264 |
---|---|
author | Kang, Seung Youn Kashlan, Osama Nezar Singh, Ravindra Rane, Rahul Adsul, Nitin Maruti Jung, Sung Chan Yi, Jihwan Cho, Hae Sun Kim, Hyeun Sung Jang, Il-Tae Oh, Seong-Hoon |
author_facet | Kang, Seung Youn Kashlan, Osama Nezar Singh, Ravindra Rane, Rahul Adsul, Nitin Maruti Jung, Sung Chan Yi, Jihwan Cho, Hae Sun Kim, Hyeun Sung Jang, Il-Tae Oh, Seong-Hoon |
author_sort | Kang, Seung Youn |
collection | PubMed |
description | BACKGROUND: With the increase in life expectancy seen throughout the world, the prevalence of degenerative spinal pathology and surgery to treat it has increased. Spinal surgery under general anesthesia leads to various problems and complications, especially in patients with numerous medical comorbidities or elderly patients. For this reason, there is a need for safer anesthetic methods applicable to unhealthy, elderly patients undergoing spinal surgery. PURPOSE: To report our experience with utilizing fluoroscopy-guided epidural anesthesia in conjunction with conscious sedation in spinal surgery. PATIENTS AND METHODS: We performed a retrospective review of 111 patients at our institution that received fluoroscopy-guided epidural anesthesia for lumbar surgery from February to September 2018. Patients’ records were evaluated to evaluate patient demographics, American Society of Anesthesiology Physical Classification System (ASA) class, and pain numerical rating scores (NRS) preoperatively and throughout their recovery postoperatively. Intraoperative data including volume of epidural anesthetic used, extent of epidural spread, and inadvertent subdural injection was collected. Postoperative recovery time was also collected. RESULTS: The mean age of our patients was 60 years old with a range between 31 and 83 years old. All patients experienced decreases in postoperative pain with no significant differences based on age or ASA class. There was no association between ASA class and time to recovery postoperatively. Older patients (age 70 years or greater) had a significantly longer recovery time when compared to younger patients. Recovery also was longer for patients who received higher volumes of epidural anesthesia. For every 1 mL increase of epidural anesthetic given, there was an increase in the extent of spread of 1.8 spinal levels. CONCLUSION: We demonstrate the safety and feasibility of utilizing conscious sedation in conjunction with fluoroscopy-guided epidural anesthesia in the lumbar spinal surgery. |
format | Online Article Text |
id | pubmed-6982434 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-69824342020-02-04 Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery Kang, Seung Youn Kashlan, Osama Nezar Singh, Ravindra Rane, Rahul Adsul, Nitin Maruti Jung, Sung Chan Yi, Jihwan Cho, Hae Sun Kim, Hyeun Sung Jang, Il-Tae Oh, Seong-Hoon J Pain Res Original Research BACKGROUND: With the increase in life expectancy seen throughout the world, the prevalence of degenerative spinal pathology and surgery to treat it has increased. Spinal surgery under general anesthesia leads to various problems and complications, especially in patients with numerous medical comorbidities or elderly patients. For this reason, there is a need for safer anesthetic methods applicable to unhealthy, elderly patients undergoing spinal surgery. PURPOSE: To report our experience with utilizing fluoroscopy-guided epidural anesthesia in conjunction with conscious sedation in spinal surgery. PATIENTS AND METHODS: We performed a retrospective review of 111 patients at our institution that received fluoroscopy-guided epidural anesthesia for lumbar surgery from February to September 2018. Patients’ records were evaluated to evaluate patient demographics, American Society of Anesthesiology Physical Classification System (ASA) class, and pain numerical rating scores (NRS) preoperatively and throughout their recovery postoperatively. Intraoperative data including volume of epidural anesthetic used, extent of epidural spread, and inadvertent subdural injection was collected. Postoperative recovery time was also collected. RESULTS: The mean age of our patients was 60 years old with a range between 31 and 83 years old. All patients experienced decreases in postoperative pain with no significant differences based on age or ASA class. There was no association between ASA class and time to recovery postoperatively. Older patients (age 70 years or greater) had a significantly longer recovery time when compared to younger patients. Recovery also was longer for patients who received higher volumes of epidural anesthesia. For every 1 mL increase of epidural anesthetic given, there was an increase in the extent of spread of 1.8 spinal levels. CONCLUSION: We demonstrate the safety and feasibility of utilizing conscious sedation in conjunction with fluoroscopy-guided epidural anesthesia in the lumbar spinal surgery. Dove 2020-01-21 /pmc/articles/PMC6982434/ /pubmed/32021410 http://dx.doi.org/10.2147/JPR.S227212 Text en © 2020 Kang et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Kang, Seung Youn Kashlan, Osama Nezar Singh, Ravindra Rane, Rahul Adsul, Nitin Maruti Jung, Sung Chan Yi, Jihwan Cho, Hae Sun Kim, Hyeun Sung Jang, Il-Tae Oh, Seong-Hoon Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title | Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title_full | Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title_fullStr | Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title_full_unstemmed | Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title_short | Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery |
title_sort | advantages of the combination of conscious sedation epidural anesthesia under fluoroscopy guidance in lumbar spine surgery |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982434/ https://www.ncbi.nlm.nih.gov/pubmed/32021410 http://dx.doi.org/10.2147/JPR.S227212 |
work_keys_str_mv | AT kangseungyoun advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT kashlanosamanezar advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT singhravindra advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT ranerahul advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT adsulnitinmaruti advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT jungsungchan advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT yijihwan advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT chohaesun advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT kimhyeunsung advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT jangiltae advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery AT ohseonghoon advantagesofthecombinationofconscioussedationepiduralanesthesiaunderfluoroscopyguidanceinlumbarspinesurgery |