00604 Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position

Name of the Procedure:

Anesthesia for Procedures on Cervical Spine and Cord; Procedures with Patient in the Sitting Position

Summary

This procedure involves administering anesthesia to a patient who is undergoing surgery or other interventions on the cervical spine (the neck portion of the spine). The patient is seated in an upright position to facilitate easier access to this area during the procedure.

Purpose

The goal is to ensure the patient remains pain-free and unconscious (or sedated, as necessary) during surgery on the cervical spine, aiding the surgeon in performing the procedure effectively while minimizing movement and discomfort.

Indications

• Cervical spine injuries or fractures
• Herniated discs in the neck
• Spinal cord compression or tumors
• Chronic neck pain not responding to conservative treatment
• Degenerative disc disease

Patient criteria include the necessity for cervical spinal surgery and the patient's ability to safely sit in an upright position.

Preparation

• Patients are typically instructed to fast for at least 8 hours prior to the procedure.
• Adjustments to medication regimens, especially blood thinners, may be required.
• Preoperative assessments including blood tests, imaging studies (e.g., MRI or CT scans), and consultations with the surgical and anesthesia teams.

Procedure Description

1. Preoperative Preparation: The patient is escorted to the surgical area and given any necessary premedication.
2. Positioning: The patient is placed in a sitting position, ensuring proper alignment and comfort.
3. Monitoring: Vital signs and other parameters are continuously monitored.
4. Anesthesia Administration: The anesthesiologist administers the appropriate anesthesia, which can include general anesthesia or regional anesthesia techniques.
5. Procedure Monitoring: The anesthesiologist monitors the patient’s condition throughout the surgery, adjusting anesthesia levels as necessary.
6. Postoperative Transition: Upon completion, the anesthesiologist gradually reduces the anesthesia and assists with the patient’s transition to recovery.

Tools and Equipment: Anesthesia delivery systems, monitoring devices, syringes, intravenous lines, and other standard anesthesia and surgical equipment.

Duration

The anesthesia administration and monitoring are ongoing throughout the cervical spine procedure, which can vary from 1 to several hours depending on complexity.

Setting

This procedure is typically performed in a hospital operating room or a specialized surgical center equipped for spinal surgery.

Personnel

• Anesthesiologist
• Surgical Team (including the neurosurgeon or orthopedic surgeon)
• Surgical Nurses
• Anesthesia Technicians

Risks and Complications

• Common risks: nausea, vomiting, sore throat (if intubation is required), and drowsiness.
• Rare risks: allergic reactions to anesthesia, nerve damage, bleeding, infection, and anesthetic complications like malignant hyperthermia.

Benefits

• Effective pain management during surgery.
• Reduced patient movement, allowing for precise surgical intervention.
• Improved surgical outcomes with potentially less postoperative pain and faster recovery.

Recovery

• Monitoring in the post-anesthesia care unit (PACU) until the patient is fully awake.
• Postoperative pain management with prescribed medications.
• Instructions for limited activity and follow-up appointments for stitch removal and progress checks.
• Recovery time varies depending on the specific surgery performed but typically ranges from a few days to several weeks.

Alternatives

• Local anesthesia with sedation for less invasive procedures.
• Conservative treatments like physical therapy, medications, or injections for conditions not requiring immediate surgery.

Pros: Alternatives may carry fewer risks and involve quicker recovery times. Cons: They may be less effective for severe conditions requiring surgical intervention.

Patient Experience

• During the procedure, the patient will be unconscious or sedated, with no sensation of pain.
• Postoperative discomfort can include throat soreness (if intubated) and mild disorientation or grogginess.
• Pain management is provided through medications to ensure comfort during recovery.