A New Neuroanesthetic Protocol of Rendering Specialized Care in Treating Degenerative Lumbar Spine Diseases in High-Risk Patients: Prospective Analysis of the Results
Kalinin A.A. Goloborodko V.Yu. Pestryakov Y.Ya. Kundubayev R.A. Biryuchkov M.Yu. Shchegolev A.V. Byvaltsev V.A.
2024Privolzhsky Research Medical University
Sovremennye Tehnologii v Medicine
2024#16Issue 351 - 59 pp.
The aim of the study is to assess the effectiveness of a new neuroanesthetic protocol for treating degenerative lumbar spine diseases in high-risk patients. Materials and Methods. Two groups of patients with a high risk of anesthesia and surgery determined by the authors’ clinical decision support system (CDSS) have been prospectively studied. A new neuroanesthetic protocol was used in the experimental group (EG, n=25), while the control group (CG, n=25) underwent intravenous anesthesia based on propofol and fentanyl. Minimally invasive transforaminal lumbar interbody fusion was performed in all cases. Changes of the intraoperative mean arterial pressure and heart rate, intensity of the local pain syndrome, amount of the opiates used, presence of cognitive disorders, adverse effects of anesthesia, and surgical complications have been compared. Results. The groups were representative (p>0.05) in terms of the age-gender parameters, anthropological data, comorbid background, involvement in smoking, preoperative characteristics of the lumbar spine, as well as the level of cognitive functions. No statistically significant changes of the mean arterial pressure (p=0.17) were registered in EG patients relative to the CG (p=0.0008). Intraoperative reduction of the heart rate in patients of the CG was not noted (p=0.49) in comparison with the EG (р=0.03). In the postoperative period, the best indicators of cognitive functions on the FAB test (p=0.02) and MoCA test (p=0.03) were revealed in EG. A significantly less amount of perioperative opiates (p=0.005) at a low level of the local pain syndrome was also noted (p=0.01). The intergroup analysis has shown fewer adverse effects of anesthesia in EG compared to CG (p=0.01) with a comparable number of postoperative surgical complications (p=0.42). Conclusion. A new neuroanesthetic protocol of rendering a specialized care to patients with a high risk of anesthesia and surgery, assessed by the authors-developed CDSS, has resulted in effective elimination of the local postoperative pain syndrome, reduction of perioperative application of opioids, and stabilization of intraoperative indicators of cardiovascular activity. In addition, no postoperative cognitive disorders, anesthetic side-effects, adverse pharmacological consequences of the complex usage of non-steroidal anti-inflammatory drugs, prolonged local anesthetics, alpha-2-agonist, and non-narcotic analgesics have been registered.
clinical decision support system , decompressive-stabilizing interventions , degenerative disease , enhanced postoperative recovery , lumbar spine , minimally invasive spine surgery
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Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, 664003, Russian Federation
Center of Neurosurgery, Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, 664003, Russian Federation
Department of Anesthesiology and Resuscitation No.1, Russian Railways–Medicine Clinical Hospital, 10 Botkin St., Irkutsk, 664005, Russian Federation
Department of Neurosurgery with the Course of Traumatology, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev St., Aktobe, 030019, Kazakhstan
Department of Military Anesthesiology and Resuscitation, S.M. Kirov Military Medical Academy, 6 Academician Lebedev St., Saint Petersburg, 194044, Russian Federation
Irkutsk State Medical Academy of Postgraduate Education, 100 Yubileyny Microdistrict, Irkutsk, 664049, Russian Federation
Department of Neurosurgery and Innovative Medicine
Center of Neurosurgery
Department of Anesthesiology and Resuscitation No.1
Department of Neurosurgery with the Course of Traumatology
Department of Military Anesthesiology and Resuscitation
Irkutsk State Medical Academy of Postgraduate Education
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