Wilson John Preston, Bonin Bryce, Quinones Christian, Kumbhare Deepak, Guthikonda Bharat, Hoang Stanley
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA.
J Clin Med. 2024 Sep 9;13(17):5326. doi: 10.3390/jcm13175326.
Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS.
清醒手术已应用于各种外科手术并取得了积极成果；然而，在神经外科领域，该技术传统上一直局限于颅脑手术。脊柱清醒手术（ASFS）是全身麻醉（GA）的一种替代方法。早期研究报告了有前景的结果，ASFS越来越受到脊柱外科医生的关注。关于接受GA的患者所面临的不良事件范围的历史已有详尽描述。GA引起的不良反应可包括术后恶心和呕吐、血流动力学不稳定及心脏并发症、急性肾损伤或肾功能不全、肺不张、肺栓塞、术后认知功能障碍，或恶性高热及其他直接药物反应。因此，许多通常被归类为GA手术不佳候选人的高风险人群可能会从ASFS的诸多优势中受益。本叙述性综述将讨论与ASFS相关的重要历史内容、相关作用机制、方案概述以及ASFS在脊柱手术中的当前发展趋势。
