Wang Lai, Du Yi, Huang Na, Yin Na, Du Junming, Yang Junlin, Jiang Lai, Mao Yanfei
Department of Anesthesiology and Surgical Intensive Care Unit.
Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Med Surg (Lond). 2024 Jan 3;86(2):643-649. doi: 10.1097/MS9.0000000000001562. eCollection 2024 Feb.
There is no expert consensus or guidance on perioperative anaesthesia management for spinal surgery of spinal muscular atrophy (SMA) patients with severe scoliosis (Cobb≧90°). We provide a comprehensive summary of the perioperative characteristics observed in patients with SMA and propose an optimized perioperative management strategy for anaesthesia.
This study is a retrospective single-centre research. Twenty-six SMA patients with severe scoliosis underwent posterior spinal fusion surgery from September 2019 to September 2022 were enroled. The main outcomes were to show the patients' characteristics in anaesthesia, intra- and post-operative periods.
Nineteen patients underwent awake transnasal/transairway intubation. The median anaesthesia time of 25 patients treated under total intravenous anaesthesia was 425 min. After operation, the Cobb angle and correction rate in the coronal plane were median 54.0° and 54.4%. The length of mechanical ventilation with endotracheal intubation in ICU was median 17.5 h in 8 patients. The ICU length of stay of postoperative hospital was median 19 days. Postoperative pneumonia developed in nine patients, atelectasis in two patients, and pleural effusion in six patients. All patients did not need special oxygen therapy after discharge.
Multidisciplinary consultation, lung-protective ventilation strategy, appropriate anaesthetic drugs and reasonable blood transfusion scheme and postoperative monitoring were important in anaesthesia, intraoperative and postoperative periods in the patients of severe scoliosis with spinal muscular atrophy.
对于患有严重脊柱侧弯（Cobb角≧90°）的脊髓性肌萎缩症（SMA）患者，脊柱手术的围手术期麻醉管理尚无专家共识或指导意见。我们对SMA患者围手术期的特征进行了全面总结，并提出了优化的围手术期麻醉管理策略。
本研究为回顾性单中心研究。纳入了2019年9月至2022年9月期间接受后路脊柱融合手术的26例患有严重脊柱侧弯的SMA患者。主要结果是展示患者在麻醉、术中和术后阶段的特征。
19例患者接受了清醒经鼻/经气道插管。25例在全静脉麻醉下接受治疗的患者的中位麻醉时间为425分钟。术后，冠状面的Cobb角和矫正率中位数分别为54.0°和54.4%。8例患者在重症监护病房（ICU）经气管插管机械通气的时长中位数为17.5小时。术后住院在ICU的停留时长中位数为19天。9例患者发生术后肺炎，2例患者发生肺不张，6例患者发生胸腔积液。所有患者出院后均无需特殊氧疗。
多学科会诊、肺保护性通气策略、合适的麻醉药物、合理的输血方案以及术后监测对于患有严重脊柱侧弯的脊髓性肌萎缩症患者的麻醉、术中和术后阶段都很重要。
