Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

Ongaigui, Corinna; Fiorda-Diaz, Juan; Dada, Olufunke; Mavarez-Martinez, Ana; Villalobos, Marco Echeverria; Bergese, Sergio D.

doi:10.3389/fsurg.2020.00045

Cited by 10 publications

(8 citation statements)

References 137 publications

(177 reference statements)

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“…Unfortunately, the presence or absence of facial oedema post-operatively in this case was not recorded, and we, therefore, cannot assume that Horner's syndrome was masked by this resulting in delayed diagnosis. However, given that facial oedema was identified in these other cases and is a known complication of surgery in the prone position [ 16 ], it is possible that the delayed presentation of Horner's syndrome, in this case, could have been due to a delayed diagnosis secondary to facial oedema.…”

Section: Discussionmentioning

confidence: 99%

Post-operative Horner’s Syndrome: A Rare Complication Following Posterior Scoliosis Surgery in a Patient With Syringomyelia

May¹,

Berg²,

Dillon³

2022

Cureus

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Horner’s syndrome following posterior spinal instrumentation for scoliosis has been rarely reported. We describe the case of a 15-year-old male who presented with right-sided ptosis, miosis, and anhidrosis after scoliosis correction. This is the first reported case of first-order Horner’s syndrome developing after scoliosis repair via posterior fixation in a patient known to have asymptomatic syringomyelia. The impression was that Horner’s syndrome developed secondary to increased traction of the syringomyelia after scoliosis repair. This is significant as a diagnosis of Horner’s syndrome can be distressing to patients and chronic cases cause cosmetic defects that might require surgical correction. We suggest that similar patients should be warned pre-operatively given the psychological distress associated with chronic Horner's syndrome. This case also illustrates the importance of an appropriate workup to rule out other sinister pathologies that can cause Horner’s syndrome.

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Section: Discussionmentioning

confidence: 99%

Post-operative Horner’s Syndrome: A Rare Complication Following Posterior Scoliosis Surgery in a Patient With Syringomyelia

May¹,

Berg²,

Dillon³

2022

Cureus

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“…Severe scoliosis and fusion segments lead to a greater blood loss during MSS surgery and result in blood perfusion disorders and abnormal coagulation function. 4 , 6 , 27 Few surgeons have applied anterior spinal release procedures combined with posterior spinal fusion to achieve good correction of scoliosis. 28 , 29 However, Qiao et al 4 proposed that the posterior spinal fusion procedure has a shorter surgery time, less blood loss, and more stable intraoperative hemodynamics than the anterior spinal release procedure.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hypotension during surgical treatment for Marfan syndrome scoliosis in children

Zhao

Yao

et al. 2022

Journal of Children's Orthopaedics

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Purpose: To explore the occurrence and risk factors of intraoperative hypotension during children’s Marfan syndrome scoliosis surgery and summarize the associated hemodynamic features and handle measures. Methods: Twenty-two Marfan syndrome scoliosis patients who underwent spinal surgery at Beijing Children’s Hospital were retrospectively reviewed between January 2001 and January 2020. Intraoperative hypotension is defined as the minimum mean arterial pressure ≤ 60 mm Hg. The patients were divided into the hypotension group and the control group. Clinical, radiographic, and operative data were compared between the two groups. The risk factors, hemodynamic features, and handle measures for intraoperative hypotension in Marfan syndrome scoliosis surgery were analyzed and summarized. Results: Twenty-two patients were included in the study, with a mean age of 11.4 years at initial surgery. The follow-up period ranged from 24 to 152 months. Intraoperative hypotension occurred in 14 cases, with an incidence of 63.6%. The proportion of pulmonary dysfunction in the hypotension group was higher than in the control group (100.0% vs 50.0%, p < 0.05). The spinal flexibility was significantly lower in the hypotension group (28.3% ± 14.2% vs 46.5% ± 11.5%, p < 0.05). Fourteen patients with intraoperative hypotension had decreased intraoperative systolic blood pressure 21.0%–50.0% compared with baseline. One patient had a transient decrease in the muscle strength of the lower limbs. No complications were observed during the follow-up. Conclusion: The incidence of intraoperative hypotension in Marfan syndrome scoliosis children who underwent surgery was 63.6%. The risk factors included preoperative pulmonary dysfunction and poor spinal flexibility. Comprehensive preoperative evaluation and effective hemodynamic handling measures should be undertaken to prevent further complications in children with Marfan syndrome scoliosis.

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“…Chang et al 48 Goal-directed fluid therapy (GDFT) is an approach to guide fluid administration to avoid fluid overload, organ hypoperfusion, and hypovolemia. 50,51 It has shown clinical benefits over traditional liberal fluid administration including enhanced postoperative recovery profiles and reduced hospital stay. 50,52 By decreasing hemodilution, GDFT can also reduce red blood cell transfusion and fluid administration.…”

Section: Error Trap 3: Failure To Prevent Excessive Bleeding Decrease...mentioning

confidence: 99%

“…50,51 It has shown clinical benefits over traditional liberal fluid administration including enhanced postoperative recovery profiles and reduced hospital stay. 50,52 By decreasing hemodilution, GDFT can also reduce red blood cell transfusion and fluid administration. 46,53 Pulse pressure variation, stroke volume variation, corrected flow time and plethysmography index variability are among the dynamic indices used to predict fluid responsiveness in GDFT trials.…”

Section: Error Trap 3: Failure To Prevent Excessive Bleeding Decrease...mentioning

confidence: 99%

“…46,53 Pulse pressure variation, stroke volume variation, corrected flow time and plethysmography index variability are among the dynamic indices used to predict fluid responsiveness in GDFT trials. 50 Unfortunately, typical approaches to prone positioning may reduce cardiac output and blunt the accuracy of some of these indices of fluid responsiveness. Interestingly, the use of the Jackson frame appears to affect cardiac output to a lesser extent allowing for a more normal predictive envelope in terms of these indices and their being predictive of fluid responsiveness.…”

Section: Error Trap 3: Failure To Prevent Excessive Bleeding Decrease...mentioning

confidence: 99%

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Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Hammon,

Chidambaran,

Templeton

et al. 2023

Pediatric Anesthesia

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Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake‐up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence‐based approaches covered in this review.

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Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

Cited by 10 publications

References 137 publications

Post-operative Horner’s Syndrome: A Rare Complication Following Posterior Scoliosis Surgery in a Patient With Syringomyelia

Post-operative Horner’s Syndrome: A Rare Complication Following Posterior Scoliosis Surgery in a Patient With Syringomyelia

Intraoperative hypotension during surgical treatment for Marfan syndrome scoliosis in children

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

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