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Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience.

Abstract

STUDY OBJECTIVE

Anesthesiologists at our hospital commonly administer spinal anesthesia for routine lumbar spine surgeries. Anecdotal impressions suggested that patients received fewer anesthesia-administered intravenous medications, including vasopressors, during spinal versus general anesthesia. We hypothesized that data review would confirm these impressions. The objective was to test this hypothesis by comparing specific elements of spinal versus general anesthesia for 1-2 level open lumbar spine procedures.

DESIGN

Retrospective single institutional study.

SETTING

Academic medical center, operating rooms.

PATIENTS

Consecutive patients (144 spinal and 619 general anesthesia) identified by automatic structured query of our electronic anesthesia record undergoing lumbar decompression, foraminotomy or microdiscectomy by one surgeon under general or spinal anesthesia.

INTERVENTIONS

Spinal or general anesthesia.

MEASUREMENTS

Numbers of medications administered during the case.

MAIN RESULTS

Anesthesiologists administered in the operating room a total of 10 ± 2 intravenous medications for general anesthetics and 5 ± 2 medications for spinal anesthetics (-5, 95% CI -5 to -4, p<0.001, univariate analysis). Multivariable analysis supported this finding (spinal versus general anesthesia: -4, 95% CI -5 to -4, p<0.001). Spinal anesthesia patients were less likely to receive ephedrine, or phenylephrine (by bolus or by infusion) (all p<0.001, Chi-squared test). Spinal anesthesia patients were also less likely to receive labetolol or esmolol (both p = 0.002, Fishers' Exact test). No neurologic injuries were attributed to, or masked by, spinal anesthesia. Three spinal anesthetics failed.

CONCLUSIONS

For routine lumbar surgery in our cohort, spinal compared to general anesthesia was associated with significantly fewer drugs administered during a case and less frequent use of vasoactive agents. Safety implications include greater hemodynamic stability with spinal anesthesia along with reduced risks for medication error and transmission of pathogens associated with medication administration.

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  • Authors+Show Affiliations

    ,

    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

    ,

    Department of Neurosurgery, Massachusetts General Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

    ,

    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

    ,

    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

    Source

    PloS one 14:6 2019 pg e0217939

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31194777

    Citation

    Deng, Hao, et al. "Spinal Anesthesia for Lumbar Spine Surgery Correlates With Fewer Total Medications and Less Frequent Use of Vasoactive Agents: a Single Center Experience." PloS One, vol. 14, no. 6, 2019, pp. e0217939.
    Deng H, Coumans JV, Anderson R, et al. Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience. PLoS ONE. 2019;14(6):e0217939.
    Deng, H., Coumans, J. V., Anderson, R., Houle, T. T., & Peterfreund, R. A. (2019). Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience. PloS One, 14(6), pp. e0217939. doi:10.1371/journal.pone.0217939.
    Deng H, et al. Spinal Anesthesia for Lumbar Spine Surgery Correlates With Fewer Total Medications and Less Frequent Use of Vasoactive Agents: a Single Center Experience. PLoS ONE. 2019;14(6):e0217939. PubMed PMID: 31194777.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience. AU - Deng,Hao, AU - Coumans,Jean-Valery, AU - Anderson,Richard, AU - Houle,Timothy T, AU - Peterfreund,Robert A, Y1 - 2019/06/13/ PY - 2019/02/20/received PY - 2019/05/21/accepted PY - 2019/6/14/entrez PY - 2019/6/14/pubmed PY - 2019/6/14/medline SP - e0217939 EP - e0217939 JF - PloS one JO - PLoS ONE VL - 14 IS - 6 N2 - STUDY OBJECTIVE: Anesthesiologists at our hospital commonly administer spinal anesthesia for routine lumbar spine surgeries. Anecdotal impressions suggested that patients received fewer anesthesia-administered intravenous medications, including vasopressors, during spinal versus general anesthesia. We hypothesized that data review would confirm these impressions. The objective was to test this hypothesis by comparing specific elements of spinal versus general anesthesia for 1-2 level open lumbar spine procedures. DESIGN: Retrospective single institutional study. SETTING: Academic medical center, operating rooms. PATIENTS: Consecutive patients (144 spinal and 619 general anesthesia) identified by automatic structured query of our electronic anesthesia record undergoing lumbar decompression, foraminotomy or microdiscectomy by one surgeon under general or spinal anesthesia. INTERVENTIONS: Spinal or general anesthesia. MEASUREMENTS: Numbers of medications administered during the case. MAIN RESULTS: Anesthesiologists administered in the operating room a total of 10 ± 2 intravenous medications for general anesthetics and 5 ± 2 medications for spinal anesthetics (-5, 95% CI -5 to -4, p<0.001, univariate analysis). Multivariable analysis supported this finding (spinal versus general anesthesia: -4, 95% CI -5 to -4, p<0.001). Spinal anesthesia patients were less likely to receive ephedrine, or phenylephrine (by bolus or by infusion) (all p<0.001, Chi-squared test). Spinal anesthesia patients were also less likely to receive labetolol or esmolol (both p = 0.002, Fishers' Exact test). No neurologic injuries were attributed to, or masked by, spinal anesthesia. Three spinal anesthetics failed. CONCLUSIONS: For routine lumbar surgery in our cohort, spinal compared to general anesthesia was associated with significantly fewer drugs administered during a case and less frequent use of vasoactive agents. Safety implications include greater hemodynamic stability with spinal anesthesia along with reduced risks for medication error and transmission of pathogens associated with medication administration. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31194777/Spinal_anesthesia_for_lumbar_spine_surgery_correlates_with_fewer_total_medications_and_less_frequent_use_of_vasoactive_agents:_A_single_center_experience L2 - http://dx.plos.org/10.1371/journal.pone.0217939 DB - PRIME DP - Unbound Medicine ER -