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NEUROSURGICAL ANESTHESIA

Anesthesia Management for Spine Surgery Using Spinal Navigation in Combination with Computed Tomography

Harald G. Fritz, MD^*, Dietmar Kuehn, MD^*, Nils Haberland, MD, and Rolf Kalff, MD PhD

*Department of Anesthesiology and Intensive Care and Neurological Surgery, University Hospital, Friedrich Schiller University, Jena, Germany

Address correspondence and reprint requests to Harald G. Fritz, MD, Department of Anesthesiology and Intensive Care, University Hospital, Bachstrasse 18, 07740 Jena, Germany. Address e-mail to Harald.Fritz{at}med.uni-jena.de

The development of a spine surgery using neuronavigation with intraoperative computed tomography (CT) is of benefit to the patient. However, the procedure also has a major impact on anesthesia management. During the procedure, the patient remains in the prone position on the CT examination table and is moved extensively during CT scans. Furthermore, there is inadequate separation between operating field and anesthetic area. Problems encountered during the procedure were patient positioning, limited patient access, long tubing, and therefore the need for adequate monitoring. We report our experience using this approach in 35 patients with spinal fracture, spinal degeneration, and tumor and describe a step-by-step anesthetic management protocol that has been developed as a guideline for use in spinal neuronavigation with intraoperative CT at our center.

IMPLICATIONS: Spine surgery using intraoperative neuronavigation in combination with intraoperative computed tomography is of benefit to the patient. Problems encountered during the procedure were patient positioning, limited patient access, long tubing, and therefore the need for adequate monitoring.