There are many advantages to using local anesthesia with IV sedation during minimally invasive spinal procedures. Agnes P. Green, MD, a board certified anesthesiologist at The Bonati Spine Institute in Hudson, Fla., discusses six things to know concerning the use of IV sedation with local anesthesia during spine surgery.
1. Preparation is the same as for general anesthesia. "The patient's preparation for local anesthesia with IV sedation is the same as preparation for general anesthesia," says Dr. Green. Prior to going into the OR, the anesthesiologist assesses the patient's medical history and identifies any areas of concern. The anesthesiologist reviews the lab studies, EKG and chest X-ray results and patients receive a physical assessment consisting of an airway, cardiac and lung evaluation. "A lot of people have the misconception that because it is conscious sedation, the preparation and the evaluation of the patient may not be as thorough, but that is not the case," she says. "Preoperatively, we fully evaluate the patient, and if we find anything that might cause concern, we address it during the preoperative period." Then, the IV sedation begins in the OR.
2. The patient is continuously monitored during surgery. Once the patient is in the OR, the anesthesiologist monitors their oxygen saturation with a pulse oximeter while the patient is continuously receiving oxygen. There is continuous monitoring of the blood pressure. The cardiac status is continuously monitored with an EKG throughout the procedure. "There is also emergency airway management equipment and cardiopulmonary support medications readily available," says Dr. Green.
3. IV sedation with local anesthesia allows the patient to maintain their airway and protective reflexes. When patients are under general anesthesia, the anesthesiologist maintains the airway for them. Conscious sedation minimally depresses the level of consciousness and patients retain their ability to maintain a patent airway and protective reflexes. The IV sedation is administered continuously through a pump and other medications are given incrementally throughout the procedure so the patient remains awake but calm.
4. Patients provide real-time feedback under local anesthesia with IV sedation. Sedation renders patients calm conscious and comfortable during spine surgery. "Conscious sedation is a very valuable tool for anesthesiologists because it allows the patient to communicate with the surgeon during the procedure, so we can receive real-time feedback," says Dr. Green. "The patient can also respond to verbal commands during the procedure."
This communication between patient and surgeon is a contributing factor to the impressive success rates achieved by the experienced surgeons at The Bonati Spine Institute. "Usually, at the end of the procedure, the surgeon will ask the patient to do any type of movements that would provoke the pain the patient had been experiencing," says Dr. Green. "By doing this, the surgeon ensures the pain has been eliminated."
5. The patient's comfort and assurance level are important. Some patients need more comfort than others. The idea of conscious sedation during spine surgery can initially be disconcerting for patients. However, Dr. Green says explaining how it works, and why it is beneficial, puts most patients at ease. When patients are under IV sedation and local anesthesia, she makes sure that they can see her Even though she explains what to expect during the procedure,, there are patients who will need more support. "Some patients want you to hold their hand or pat them on the shoulder. We do everything we can to reassure the patient so they will feel comfortable and completely at ease,” says Dr. Green.
6. Local anesthesia with IV sedation is safe for the patient. The local anesthesia is administered by the surgeon who anesthetizes the skin and deeper tissues.
"The anesthesiologist is in constant communication with the surgeon relative to the maximum and safe dose of the local anesthetics," says Dr. Green.
Learn more about The Bonati Spine Institute.
Read other coverage on orthopedic and spine anesthesia:
- 5 Points About Successful Anesthesia For Orthopedic and Spine Surgery
- 5 Thoughts on the Physician Supervision of Anesthesia Rule From ASA President Dr. Mark Warner
- Manipulation Under Anesthesia: Possible Revenue Source for Orthopedic ASCs
1. Preparation is the same as for general anesthesia. "The patient's preparation for local anesthesia with IV sedation is the same as preparation for general anesthesia," says Dr. Green. Prior to going into the OR, the anesthesiologist assesses the patient's medical history and identifies any areas of concern. The anesthesiologist reviews the lab studies, EKG and chest X-ray results and patients receive a physical assessment consisting of an airway, cardiac and lung evaluation. "A lot of people have the misconception that because it is conscious sedation, the preparation and the evaluation of the patient may not be as thorough, but that is not the case," she says. "Preoperatively, we fully evaluate the patient, and if we find anything that might cause concern, we address it during the preoperative period." Then, the IV sedation begins in the OR.
2. The patient is continuously monitored during surgery. Once the patient is in the OR, the anesthesiologist monitors their oxygen saturation with a pulse oximeter while the patient is continuously receiving oxygen. There is continuous monitoring of the blood pressure. The cardiac status is continuously monitored with an EKG throughout the procedure. "There is also emergency airway management equipment and cardiopulmonary support medications readily available," says Dr. Green.
3. IV sedation with local anesthesia allows the patient to maintain their airway and protective reflexes. When patients are under general anesthesia, the anesthesiologist maintains the airway for them. Conscious sedation minimally depresses the level of consciousness and patients retain their ability to maintain a patent airway and protective reflexes. The IV sedation is administered continuously through a pump and other medications are given incrementally throughout the procedure so the patient remains awake but calm.
4. Patients provide real-time feedback under local anesthesia with IV sedation. Sedation renders patients calm conscious and comfortable during spine surgery. "Conscious sedation is a very valuable tool for anesthesiologists because it allows the patient to communicate with the surgeon during the procedure, so we can receive real-time feedback," says Dr. Green. "The patient can also respond to verbal commands during the procedure."
This communication between patient and surgeon is a contributing factor to the impressive success rates achieved by the experienced surgeons at The Bonati Spine Institute. "Usually, at the end of the procedure, the surgeon will ask the patient to do any type of movements that would provoke the pain the patient had been experiencing," says Dr. Green. "By doing this, the surgeon ensures the pain has been eliminated."
5. The patient's comfort and assurance level are important. Some patients need more comfort than others. The idea of conscious sedation during spine surgery can initially be disconcerting for patients. However, Dr. Green says explaining how it works, and why it is beneficial, puts most patients at ease. When patients are under IV sedation and local anesthesia, she makes sure that they can see her Even though she explains what to expect during the procedure,, there are patients who will need more support. "Some patients want you to hold their hand or pat them on the shoulder. We do everything we can to reassure the patient so they will feel comfortable and completely at ease,” says Dr. Green.
6. Local anesthesia with IV sedation is safe for the patient. The local anesthesia is administered by the surgeon who anesthetizes the skin and deeper tissues.
"The anesthesiologist is in constant communication with the surgeon relative to the maximum and safe dose of the local anesthetics," says Dr. Green.
Learn more about The Bonati Spine Institute.
Read other coverage on orthopedic and spine anesthesia:
- 5 Points About Successful Anesthesia For Orthopedic and Spine Surgery
- 5 Thoughts on the Physician Supervision of Anesthesia Rule From ASA President Dr. Mark Warner
- Manipulation Under Anesthesia: Possible Revenue Source for Orthopedic ASCs