Neuroanesthetic care in surgical treatment of degenerative lumbar spine diseases in high-risk patients is associated with an increased number of perioperative complications, prolongation of hospital-stay and increased costs.

OBJECTIVE

To analyze an effectiveness of optimization program of neuroanesthesia in surgical treatment of degenerative lumbar spine diseases in patients with high risk factors.

MATERIAL AND METHODS

We compared the course of anesthesia and early postoperative period after lumbar decompression-stabilization interventions, clinical and laboratory data, as well as the number of adverse effects of anesthesia. Analysis was carried out in groups of patients with overweight — the main group (MG) I (n=37) and clinical comparison group (CCG) I (n=49). Another pair for comparison included elderly patients — MG II (n=31) and CCG II (n=34). In the MG I and II, we used multimodal anesthesia with dexmedetomidine, tranexamic acid, paravertebral muscle infiltration with bupivacaine and epinephrine, as well as minimally invasive surgical techniques. In both CCGs, conventional intravenous anesthesia with mechanical ventilation was applied during open fusion surgery.

RESULTS

Better best results regarding restoration of psychomotor functions and no significant hemodynamic changes were obtained in the main groups. An efficacy of multimodal anesthesia with dexmedetomidine and local anesthesia was confirmed by significantly lower need for intraoperative opioid drugs (p<0.001) and glucose level (p<0.05) in the main groups. Local anesthesia significantly reduced local pain (p<0.05) and the need for analgesics (p<0.05). An effectiveness of tranexamic acid was confirmed by less blood loss (p<0.001) and transfusions (p<0.001), as well as no significant coagulation impairment (p<0.05) in both main groups. Incidence of anesthesia-induced adverse effects was 5.4% in MG I, 32.6% in CCG I (p=0.002); 12.9% in MG II and 41.2% in CCG II (p=0.001). Postoperative incidence of surgical complications was 2.7% in MG I, 14.3% in CCG I (p=0.006); 3.2% in MG II and 14.7% in GCS II (p=0.003).

CONCLUSION

Effectiveness and safety of optimization program of neuroanesthesia in surgical treatment of degenerative lumbar spine diseases in patients with high risk factors (overweight and elderly) are confirmed by normal perioperative hemodynamics, less time of surgery and anesthesia by 25%, reduced perioperative blood loss by 3 times and blood transfusions in all cases, 2-fold decrease in amount of injected opioids and less need for postoperative anesthesia by 4 times, quick and complete restoration of psychomotor functions without prolongation of ICU-stay, as well as decrease of the incidence of anesthesia-induced adverse effects by 25% and postoperative surgical complications by 10%.