Medical Student Tufts University School of Medicine Boston, Massachusetts, United States
Disclosure(s):
Michelle Olmos, BA: No financial relationships to disclose
Introduction: Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Though POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others.
Methods: Demographic and procedural data of 424 consecutive TLIF patients was extracted retrospectively. Patients undergoing single level TLIF via GEA (n=186) or SA (n=238) were enrolled into our database. Perioperative medications, excluding antibiotic prophylaxis and local anesthetics, were classified into various categories.
Results: Patients in the SA cohort received a mean of 4.5 medications versus a mean of 10.5 medications in the GEA cohort (p < 0.0001). This reduction in perioperative medications remained significant after a multivariate analysis to control for confounders (p < 0.001 for all variables). Use of vasopressors was significantly reduced in the SA cohort (p < 0.001), which coincided with a significant reduction in hypotensive episodes (p < 0.001). Patients undergoing TLIF via GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (OR=3.62, 95% CI [2.38-5.49]).
Conclusion : Spinal anesthesia is associated with a significant decrease in perioperative medications and may confer superior intraoperative hemodynamic stability which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs though this requires further study.
