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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 42

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 42. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Intraoperative Anesthesia Management Chapter 15 393 Figure 2. Eye and face protection Details of the eye a and face protection b in a patient having anterior C-spine surgery due to trauma. The eyes are covered with cream and seal and are then padded to avoid damage by pressure or sharp objects. Nasogastric tube is in place. After deployment of the surgical retractors in anterior cervical spine surgery the pressure inside the endotracheal tube cuff frequently reaches 40-50 mmHg. It should be rechecked in order to maintain it between 15 and 20 mmHg this is even more important if the anesthetist is using N2O in the gas mixture due to its fast diffusion into the cuff. These marked increases in the cuff pressure along with lengthy total intubation time are frequently reported to elevate tracheal and pharyngeal morbidity such as hoarseness and vocal cord palsy 3 . Once the surgical team finishes positioning the patient it is wise to confirm that the endotracheal tube has not moved and that bilateral ventilation and breath sounds are adequate. It is also a good time to verify that the bronchial blocker is still in the right place if one lung ventilation is desired. Antibiotic Prophylaxis Postoperative infections in spine surgery are primarily monomicrobial although in about half of infected patients more than one organism can be identified. The bacteria most commonly cultured from wounds are Staphylococcus aureus and epidermidis 17 . Postoperative infections occur in 0.3-9 of patients undergoing spine surgery 75 . Increased risk of spine postoperative infections has been associated with Routine antibiotic prophylaxis today is standard in spinal surgery staged procedures blood loss in excess of 1000 ml surgery longer than 4 h smoking diabetes malnutrition obesity immunocompromised patients alcoholism posterior approach postoperative incontinence 394 Section Peri- and Postoperative Management Redose antibiotics in cases with prolonged surgery and or substantial blood loss .