Anesthesia Concerns for Spinal Fusion Surgery

Q: Anesthesia Concerns for Spinal Fusion Surgery

Hello： First, I would like to know if you are an athlete. <br>Athletes can experience "bradycardia" (a heart rate of less than 60 beats per minute). <br>However, if the heart rate drops below 30 beats per minute, it is still necessary to have a cardiologist confirm the physiologi

Anesthesia issues

Scheduled for December 9, I will undergo internal fixation lumbar spinal fusion surgery due to L5-S1 vertebral fracture complicated by nerve traction.
The anesthesia method will be GA-TUBE.
I would like to ask a few questions.
During my last knee arthroscopy, I also received general anesthesia, but I lay in the recovery room for over three hours.
The nurse mentioned that there were instances of arrhythmia and bradycardia, with previous records showing a heart rate of 29-33 beats per minute and blood pressure above 150-170 (while in the ward).
During this anesthesia consultation, the physician suggested that it might be a side effect of the anesthetic, but he was unsure why I remained in the recovery room for a full three hours.
However, he noted significant fluctuations in my heart rate, ranging from approximately 33 to 61 beats per minute, and I subsequently consulted a cardiologist, who confirmed the presence of arrhythmia.
I have a few questions:
1.
If I encounter this issue during the spinal surgery, is it possible that I would be sent to the ICU?
2.
Is it necessary to place a central venous catheter during spinal surgery?
3.
What is the approximate time frame from the pre-anesthesia preparations to the end of the surgery?
4.
Is intubation anesthesia the type that causes significant throat discomfort upon waking?
Thank you for the anesthesiologist's response, and I appreciate your hard work.

Mr. Chen, 30~39 year old female. Ask Date: 2019/11/24

Dr. Lin Xiuying reply Anesthesiology

Hello: First, I would like to know if you are an athlete.
Athletes can experience "bradycardia" (a heart rate of less than 60 beats per minute).
However, if the heart rate drops below 30 beats per minute, it is still necessary to have a cardiologist confirm the physiological safety of the heart before surgery! If it is "pathological bradycardia," there may even be a need for a pacemaker.
The reason for the three-hour recovery room care post-surgery depends on the explanation provided by the attending physician at that time, which could relate to your condition; of course, it could also be a general administrative issue...
It is indeed necessary to remind the responsible surgical and anesthesiology physicians!
Regarding the questions you raised:
1.
If this spinal surgery encounters this issue, is it possible to be sent to the ICU? → It still depends on the specific situation and the safety of post-operative care in the general ward.
In other words, if you are at risk of unstable vital signs after surgery (or during surgery), there needs to be adequate personnel and close monitoring.
Therefore, it should be determined based on communication between the anesthesiologist and the surgeon.
2.
Is it necessary to place a central venous catheter during spinal surgery? → This depends on the anesthesiologist's (and possibly the surgeon's) assessment of the physiological risks and needs for the patient's anesthesia and surgery.
It is important to understand that every procedure carries some level of risk, and it is reasonable to place a catheter only if necessary.
3.
What is the approximate time from pre-anesthesia preparation to the end of the surgery? → This varies.
It will depend on the surgeon's skills, instruments used, the cooperation of assistants, and whether any invasive monitoring procedures (such as placing a central venous catheter, as you mentioned) are needed before surgery, among other factors.
However, from the time you enter the operating room for anesthesia until you wake up from anesthesia, it will take "at least" two hours, and it could be five to six hours or more.
It would be more appropriate to ask your attending surgeon for details (though surgeons usually only indicate the duration of the surgery).
4.
Is intubation anesthesia the kind that makes your throat feel very uncomfortable upon waking? → Yes! Typically, since you will be undergoing surgery in a prone position exposing your back and waist, general anesthesia with endotracheal intubation is necessary to ensure airway safety.
Wishing you a smooth surgery and recovery from anesthesia!

Reply Date: 2019/11/24

More Info

Understanding anesthesia concerns for spinal fusion surgery, especially in the context of your previous experiences, is crucial for ensuring a safe and effective surgical outcome. Given your history of bradycardia (slow heart rate) and arrhythmias during your last surgery, it is understandable that you have several questions regarding the upcoming procedure.

1. ICU Admission Possibility: If you experience significant cardiovascular instability during or after the spinal fusion surgery, there is a possibility that you may be transferred to the Intensive Care Unit (ICU) for closer monitoring. Factors that would influence this decision include the severity of your heart rate fluctuations, blood pressure stability, and overall clinical status post-surgery. The anesthesiologist and the surgical team will assess your condition continuously and make decisions based on your vital signs and responsiveness.

2. Central Venous Catheter (CVC) Requirement: The need for a central venous catheter during spinal surgery is determined by the anesthesiologist based on your individual risk factors and the complexity of the procedure. CVCs are typically used for patients who may require extensive fluid management, have a history of difficult venous access, or need medications that are better administered centrally. Your medical history, including your heart condition, will be taken into account when making this decision.

3. Duration from Pre-Anesthesia to Surgery Completion: The time from pre-anesthesia preparation to the end of the surgery can vary significantly based on several factors, including the complexity of the procedure, the surgical team's efficiency, and whether any complications arise. Generally, the entire process can take anywhere from 2 to 6 hours. This includes time for pre-operative assessments, anesthesia induction, the surgical procedure itself, and post-anesthesia recovery.

4. Endotracheal Intubation Discomfort: Yes, it is common for patients to experience throat discomfort after being intubated for general anesthesia. This is due to the presence of the endotracheal tube, which can irritate the throat. While this discomfort is usually temporary, it can be bothersome. Your anesthesiologist may provide medications to help alleviate this discomfort post-operatively.

In addition to these specific concerns, it is essential to communicate openly with your surgical and anesthesia team about your previous experiences and any ongoing health issues. They may recommend additional monitoring or interventions to ensure your safety during the upcoming surgery.
Furthermore, considering your history of heart rhythm issues, it might be beneficial to have a pre-operative consultation with a cardiologist to assess your cardiac health and ensure that you are optimized for surgery. This could include an evaluation of your heart function, potential adjustments to your medications, and a discussion about any necessary precautions during the anesthesia process.

Lastly, post-operative care is equally important. After surgery, you may experience side effects from anesthesia, such as nausea, dizziness, or fatigue. It is crucial to report any concerning symptoms to your healthcare team promptly. They can provide supportive care and interventions to manage these symptoms effectively.

In summary, your concerns regarding anesthesia for spinal fusion surgery are valid and should be addressed thoroughly with your healthcare providers. By ensuring clear communication and thorough pre-operative assessments, you can help minimize risks and enhance your recovery experience. Wishing you a successful surgery and a smooth recovery!

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