Research Article
Anesthesia For Endoscopic Spine Surgery Of The Spine In
an Ambulatory Surgery Center
João Abrão1, Antoine Louis Jacques M2, Álvaro Dowling3 and Kai-Uwe Lewandrowski4*
1Professor of Anesthesiology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
2Head of Anesthesia, Surgical Institute of Tucson, USA
3Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Chile
4Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, USA
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Sedation in ASC has to allow a patient to undergo a potentially unpleasant and painful procedure by making it tolerable and more comfortable to the patient. Sedation is a continuous process of
decreasing consciousness ranging from anxiolysis to a deep state where nociception is significantly reduced. 28 For spinal endoscopy, the anesthesiologist should aim for a short time onset of sedation
combined with a rapid and consistent recovery profile. The sedative concentration should ideally not be associated with any adverse hemodynamics, respiratory, and metabolic consequences. The
sedative drugs most used in ambulatory sedation were midazolam,propofol, ketamine, dexmedetomidine, remifentanil, and fentanyl.
There is a new benzodiazepine, remimazolam, under investigation
in phase three clinical trials. It may be in clinical applications in the future.
Comfortable position of the patient on the operating table is often supervised by default by the anesthesiologist and is relevant as to position the patient in such way that allows best ventilation.
Adequate and comfortable position in the prone position on a lordotic frame or chest rolls is of particular importance. Local anesthesia should be used by the surgeon to anesthetize the entire
surgical access corridor and the surgical site, which in the case of cervical endoscopy entails skin anesthesia, the paraspinal cervical muscles, and the facet joint complex. The concomitant use of longacting local anesthetic may not only diminish painful stimulus during surgery but also control postoperative pain and avoid a dysphoric wake in the recovery room. To achieve the right sedation
level and comfort in the patient undergoing spinal endoscopy, the anesthesiologist has to perceive and anticipate situations where the patient may feel severe pain and needs to be responsive and
cooperative. Since the surgeon may concentrate on the operation, the anesthesiologists should also rely on assessing the stimulation level on his monitors.
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