DOI: 10.1097/ANA.0b013e3182a515f0
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Issn Print: 0898-4921
Publication Date: 2014/07/01
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Excerpt
Anesthesia for Spine Surgery is divided into 4 major sections. “General Considerations” (section 1) includes 7 chapters. Each chapter is an excellent review of basic anesthetic topics pertinent to spine surgery: preoperative assessment, fluid management, blood conservation, airway management specific to spine surgery, spine imaging, evoked potential monitoring, and pharmacology of adjunct anesthesia drugs. Each of these chapters is a “stand-alone mini-treatise.” These chapters are well written, providing a concise presentation of the subject, and some include new research topics that are relevant to clinical practice. For example, the Fluid management chapter discusses the role of the endothelial glycocalyx—a thin layer on the vascular endothelial surface that is associated with regulation of vascular filtration, immune response, and the coagulation system. It is exciting to see a basic science concepts introduced in a relevant manner in a clinical textbook.
I am so impressed with these introductory chapters that I am using them as survey/summary references for resident education. Some chapters will be used specifically for the rotating neuroanesthesia residents, and some for other appropriate cases. The Preoperative assessment of the adult patient chapter guides evaluation in the preanesthesia clinic. The Fluid management and blood conservation chapters are relevant to all anesthesiologists. Even though I have been involved with neuroanesthesia for many years, I learned new helpful techniques in Airway management maneuvers from this chapter. The Spine imaging chapter is extremely well written with excellent radiographs of the relevant x-ray features. In many textbooks radiographs are poorly reproduced and the readers often are unsure of what they are viewing. This is certainly not the case with this chapter (or for all the illustrations/diagrams/photographs throughout the entire book)! The Evoked potential monitoring chapter presents this topic in appropriate detail for an anesthesiologist—but not so detailed that the reader becomes bored or confused. It discusses the usefulness of evoked potential monitoring (somatosensory evoked potentials [SSEP] transcranial motor evoked potentials [TcMEP], electromyography [EMG], pedicle screw stimulation) and discusses the results of outcome studies. I was curious what the Pharmacology chapter could cover in 7 pages, and was pleased with the relevant scope and coverage. It provides brief descriptions of drug utilization and effects specifically relevant to spine surgery and electrophysiology monitoring.
Section 2 describes “Spine Surgery for Adults.” It includes interesting and descriptive presentations by both spine surgeons and anesthesiologists. The sections written by the spine surgeons describe the different surgical approaches. I found these to be extremely useful, given the new approaches to spine surgery. An example is the section on Chiari malformation type 1 surgery. In <5 pages (including 4 excellent illustrations) the authors provided a succinct discussion of the clinical manifestations, pathophysiology, and surgical techniques, even detailing the endoscopic approach. The sections on minimally invasive spine surgery are very informative. Interestingly, both the surgeon-written and the anesthesiologist-written sections state that “minimally invasive” does not mean shorter or less-bloody surgeries. The use of high-dose steroids for spinal cord injury is candidly discussed—90% of spine surgeons use this treatment, whereas only 24% believe that it provides a clinical benefit.
