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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...

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Autores principales: 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
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
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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.
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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
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