الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Summary
Anaesthesia for surgery of vertebral column:
Vertebral column forms the central axis of the body, supports the trunk and the head on the pelvis, and suspends body weight to the lower limbs and encloses and protects the spinal cord. It has highly mobile regions and other fixed ones.
It has different pathological conditions varying between congenital or acquired deformities, degenerative diseases, traumatic lesions and tomours, with their effects on patient’s life and pathophysiological consequences to other body organs,
Acute traumatic lesions represent a challenge to the anaesthiologist as they need a very meticulous and highly skilled management with special care to the respiration and cardiovascular systems which may be affected in these conditions as a result of interruption of there innervations, this also needs a special care during intubation, not to complicate the already present cervical lesion.
Congenital deformities are usually associated with other anomalies either in cardiovascular, respiratory or renal systems. These anomalies should be considered during anaesthetic management. While degenerative diseases like disc prolapse, especially in the lumbar region, represent a considerable percentage of the vertebral column surgery causes.
The anaesthesia for scoliosis correction surgery needs a special care with the preoperative, intraoperative management, monitoring and postoperative care, due to its effects on respiratory and cardiovascular and the may be associated congenital cardiac anomalies.
Recommended preoperative management of chronic patients include: patient interview by the anaesthesiologist the day before surgery and sedatives administration like diazepam. Intraoperative management includes positioning which may be prone, supine, lateral or sitting position. Each position has special indications and complications. Beside the basic patient monitoring, like ECG and BP, there are special monitoring techniques like the wake-up test, the SSEPs and the MEPs; which can predict the success of the correction surgery and allow intraoperative reassessment of the procedure with correction. They also alarm for the possible decrease in spinal cord perfusion.
Problems met with during anaesthesia and surgery include extensive blood loss, hypotension, hypothermia and malignant hyperthermia. Blood loss can be decreased by the use of drugs such as sodium nitroprusside, and control of patient positioning.
Malignant hyperthermia is diagnosed by increased body temperature, tachycardia, tachypnea, arrhythmia and change of blood pressure. It is treated with cessation of the use of halothane, cooling of the patient and using dantrolene and continuing surgery by the use of N2o/O2. One of the most devastating postoperative problems is the postoperative visual loss; so meticulous care to its causes and risk factors should be a goal for the anaesthesiologist.
Recovery, from anaesthesia should be as smooth as possible, and after operation anaesthesiologist must notice the patients respiration, blood pressure, heart rate and body temperature, then the: endotracheal tube is withdrawn after suction of secretions and the patient regains his normal respiration. Certain criteria are needed to extubate the patient, otherwise mechanical ventilation should be stand-by.
Postoperative pain in vertebral column surgery is one of the most annoying problems for the patient and the medical staff, so many techniques and modalities for this problem may be used.