How to start an awake spine program: Protocol and illustrative cases

Waguia, Romaric; Touko, Elisabeth Kakmou; Sykes, David A.W.; Kelly-Hedrick, Margot; Hijji, Fady Y.; Sharan, Alok; Foster, Norah; Abd-El-Barr, Muhammad M.

doi:10.1016/j.ibneur.2022.05.009

Cited by 7 publications

(6 citation statements)

References 40 publications

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“…When patients were surveyed about their willingness to participate in a randomised trial of spinal vs. general anaesthesia the results were somewhat contrasting; 60% stated they would take part in such a study [10]. Establishing an awake spinal surgery programme would require multi‐professional support and sufficient education to both patients and healthcare providers of the potential benefits, including improved peri‐operative outcomes and reduced financial and environmental costs [11].…”

Section: Neurosurgical Anaesthesiamentioning

confidence: 99%

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Oliver,

Charlesworth,

Pratt

et al. 2024

Anaesthesia

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SummaryThe principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence‐based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.

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Section: Neurosurgical Anaesthesiamentioning

confidence: 99%

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Oliver,

Charlesworth,

Pratt

et al. 2024

Anaesthesia

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“…A perioperative protocol for awake spinal surgery has been described based on multiple studies (Fig. 2) [17,39,43 ▪ ,44 ▪ ].…”

Section: Perioperative Pathway: Fast-track Protocol For Same-day Neur...mentioning

confidence: 99%

“…Perioperative protocol for awake spinal surgery in same-day neurosurgery setting [17,39,43 ▪ ,44 ▪ ]. ACDF, anterior cervical disc decompression and fusion; ERANS, enhanced recovery after neurosurgery; ESP, erector spinae plane; LA, local anesthesia; MMA, multimodal analgesia; PACU, postanesthesia care unit; PONV, postoperative nausea and vomiting; TLIP, thoracolumbar interfascial plane.…”

Section: Perioperative Pathway: Fast-track Protocol For Same-day Neur...mentioning

confidence: 99%

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

Ajayan

Hrishi

Rath

2023

Current Opinion in Anaesthesiology

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Purpose of review This article delves into recent advances in same-day neurosurgery (SDNS), specifically concerning indications, perioperative protocol, safety, and outcomes. Additionally, it explores the recent updates on awake craniotomy and awake spine surgery. Recent findings There is an evolving body of literature on studies about SDNS that reaffirm its safety and feasibility. awake craniotomy is associated with lesser neurological deficits and better survival benefits in patients with lesions in eloquent areas. Monitored anesthesia care, compared with the asleep–awake–asleep technique, is associated with lower failure rates, shorter procedure time, and shorter length of stay. However, the incidence of intraoperative seizures is lower with the asleep–awake–asleep technique. Propofol-based and dexmedetomidine-based anesthesia are similar with regard to procedure duration, intraoperative adverse events, and patient satisfaction; however, surgeon satisfaction is higher with dexmedetomidine-based anesthesia. In spine surgery, regional anesthesia when compared with general anesthesia, is associated with less intraoperative blood loss and a lower incidence of postoperative nausea and vomiting after 24 h. In addition, implementing an enhanced multimodal analgesia protocol improved disability scores and reduced the likelihood of postoperative complications. Summary SDNS offers promising prospects for patients and healthcare providers alike, with the potential to provide well tolerated, efficient, and cost-effective neurosurgical care in carefully selected cases.

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Section: Special Considerations and Highlights In Adult Spine Surgeriesmentioning

confidence: 99%

“…To expedite recovery, shorter operating room times, earlier ambulation, and to mitigate the effects of GA, lumbar laminectomies, discectomies, and fusions are possible in awake patients. 80 Regional techniques play an important role in this setting and make awake surgeries easy and successful. 81 Careful selection of patients is crucial, as this option is available only to patients who can lie still in a prone position, who do not have significant anxiety or airway risks, and who are undergoing short and minimally invasive procedures.…”

Section: Awake Spine Surgerymentioning

confidence: 99%

Perioperative pain management for spine surgeries

Sikachi,

Oliver,

Oliver

et al. 2023

International Anesthesiology Clinics

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How to start an awake spine program: Protocol and illustrative cases

Cited by 7 publications

References 40 publications

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

Perioperative pain management for spine surgeries

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