Analysis of Risk Factors for the Development of Unsatisfactory Long-Term Clinical Results of Performance of Multi-Level Decompressive-Stabilizing Interventions on the Lumbar Spine

Byvaltsev, V.A.; Goloborodko, V.Yu.; Kalinin, A.A.

doi:10.17513/spno.29304

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…We have previously found [24] the causes of unsatisfactory results of decompressive-stabilizing interventions at the lumbar level: female gender, age of 65 and older, body mass index of 25 or greater, ASA III and above, smoking status, blood loss exceeding 500 ml, comorbid pathology, general anesthesia longer than 180 min, a type of the surgical method. Based on the results of the mixed-effects logistic regression model, numeric values (points) were determined for each parameter and threshold values for the risk of unsatisfactory postoperative outcome: low risk up to 5 points, moderate risk from 6 to 8 points, high risk over 8 points.…”

Section: Discussionmentioning

confidence: 99%

A New Neuroanesthetic Protocol of Rendering Specialized Care in Treating Degenerative Lumbar Spine Diseases in High-Risk Patients: Prospective Analysis of the Results

Kalinin,

Goloborodko,

Pestryakov

et al. 2024

Sovrem Tehnol Med

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The aim of the study is to assess the effectiveness of a new neuroanesthetic protocol for treating degenerative lumbar spine diseases in high-risk patients. Materials and Methods Two groups of patients with a high risk of anesthesia and surgery determined by the authors’ clinical decision support system (CDSS) have been prospectively studied. A new neuroanesthetic protocol was used in the experimental group (EG, n=25), while the control group (CG, n=25) underwent intravenous anesthesia based on propofol and fentanyl. Minimally invasive transforaminal lumbar interbody fusion was performed in all cases. Changes of the intraoperative mean arterial pressure and heart rate, intensity of the local pain syndrome, amount of the opiates used, presence of cognitive disorders, adverse effects of anesthesia, and surgical complications have been compared. Results The groups were representative (p>0.05) in terms of the age-gender parameters, anthropological data, comorbid background, involvement in smoking, preoperative characteristics of the lumbar spine, as well as the level of cognitive functions. No statistically significant changes of the mean arterial pressure (p=0.17) were registered in EG patients relative to the CG (p=0.0008). Intraoperative reduction of the heart rate in patients of the CG was not noted (p=0.49) in comparison with the EG (p=0.03). In the postoperative period, the best indicators of cognitive functions on the FAB test (p=0.02) and MoCA test (p=0.03) were revealed in EG. A significantly less amount of perioperative opiates (p=0.005) at a low level of the local pain syndrome was also noted (p=0.01). The intergroup analysis has shown fewer adverse effects of anesthesia in EG compared to CG (p=0.01) with a comparable number of postoperative surgical complications (p=0.42). Conclusion A new neuroanesthetic protocol of rendering a specialized care to patients with a high risk of anesthesia and surgery, assessed by the authors-developed CDSS, has resulted in effective elimination of the local postoperative pain syndrome, reduction of perioperative application of opioids, and stabilization of intraoperative indicators of cardiovascular activity. In addition, no postoperative cognitive disorders, anesthetic side-effects, adverse pharmacological consequences of the complex usage of non-steroidal anti-inflammatory drugs, prolonged local anesthetics, alpha-2-agonist, and non-narcotic analgesics have been registered.

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Section: Discussionmentioning

confidence: 99%