Minerva anestesiologica
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Minerva anestesiologica · May 2022
ReviewPerioperative management in complex spine surgery: a narrative review.
The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multilevel spinal arthrodesis and osteotomies. ⋯ We will discuss preoperative concerns, intraoperative management including airway management, choice of maintenance, intraoperative neuromonitoring and anesthetic effect, blood management and the dynamic topic of anesthetic and analgesic techniques. Finally, we will briefly address the issue of perioperative complications as they relate specifically to spine surgery.
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Minerva anestesiologica · May 2022
High flow nasal oxygen, procedural sedation, and clinical governance.
Procedural sedation for therapeutic and diagnostic procedures can now be achieved through deep sedation techniques that guarantee procedural success. Deep sedation techniques are delivered in a variety of non-theatre environments where the usual levels of anesthetic equipment are not practical or economical. Hypoxic events are particularly frequent, and challenge sedation providers. ⋯ Deep sedation services are increasingly applied to subjects with complex co-morbidities, sometimes excluded for safety reasons from surgery under general anesthesia. The development of deep sedation services, delivered by non-anesthesia personnel, to patients with complex co-morbidities requires that services implement appropriate clinical governance tools to prevent deep sedation being the wild west of anesthesia services. Therefore, whilst high flow nasal oxygen may reduce the incidence of peri-procedural hypoxia, the introduction of clinical governance tools and the systematic introduction of initiatives to improve quality, will maintain the safety of deep sedation services.