Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Anesthesia, Tufts Medical Center, Boston, Massachusetts, USA.
Neurosurgery. 2023 Mar 1;92(3):632-638. doi: 10.1227/neu.0000000000002259. Epub 2022 Nov 24.
Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Although POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others.
To determine whether SA reduced polypharmacy compared with GEA in patients undergoing transforaminal lumbar interbody fusion (TLIF).
Demographic and procedural data of 424 consecutive TLIF patients were extracted retrospectively. Patients undergoing single-level TLIF through GEA (n = 186) or SA (n = 238) were enrolled into our database. Perioperative medications, excluding antibiotic prophylaxis and local anesthetics, were classified into various categories.
Patients in the SA cohort received a mean of 4.5 medications vs a mean of 10.5 medications in the GEA cohort ( P < .0001). This reduction in perioperative medications remained significant after a multivariate analysis to control for confounders ( P < .001 for all variables). The use of vasopressors was significantly reduced in the SA cohort ( P < .001), which coincided with a significant reduction in hypotensive episodes ( P < .001). Patients undergoing TLIF through GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (odds ratio = 3.62, 95% CI [2.38-5.49]).
Spinal anesthesia is associated with a significant decrease in perioperative medications and may confer superior intraoperative hemodynamic stability, which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs, although this requires further study.
椎管内麻醉（SA）是一种安全有效的替代全身气管内麻醉（GEA）的方法，用于腰椎手术。避免 GEA 的首要原因是希望尽量减少术后认知功能障碍（POCD）。虽然 POCD 是一种复杂的多因素实体，但发展风险与麻醉方式和围手术期多药治疗等因素有关。
确定在接受经椎间孔腰椎体间融合术（TLIF）的患者中，SA 是否比 GEA 减少了多药治疗。
回顾性提取 424 例连续 TLIF 患者的人口统计学和程序数据。我们的数据库中纳入了接受单节段 TLIF 的患者，包括接受 GEA（n = 186）或 SA（n = 238）的患者。除抗生素预防和局部麻醉剂外，围手术期药物被分为各种类别。
SA 组患者平均接受 4.5 种药物治疗，而 GEA 组患者平均接受 10.5 种药物治疗（P <.0001）。在控制混杂因素的多变量分析中，这种围手术期药物的减少仍然具有统计学意义（所有变量 P <.001）。SA 组患者使用血管加压药的比例显著降低（P <.001），同时低血压发作的发生率也显著降低（P <.001）。接受 GEA 行 TLIF 的患者术中发生低血压发作的可能性是 SA 组的 3.6 倍（比值比=3.62，95%CI [2.38-5.49]）。
椎管内麻醉与围手术期药物的显著减少相关，并且可能提供术中更好的血流动力学稳定性，从而降低升压需求。减少围手术期药物治疗可能是降低接受 TLIF 患者 POCD 发生率的一个重要贡献，尽管这需要进一步研究。
