Anesthesia for ankylosing spondylitis patients undergoing transpedicle vertebrectomy

Area of Science:

• Anesthesiology
• Spinal Surgery
• Skeletal Disorders

Background:

• Ankylosing Spondylitis (AS) presents significant anesthetic challenges, including difficult airway management, central venous access, positioning, and potential for massive blood loss.
• Transpedicle vertebrectomy (TPV) in AS patients requires specialized anesthetic considerations.

Purpose of the Study:

• To retrospectively review the anesthetic management of consecutive AS patients undergoing TPV.
• To identify and address the specific anesthetic challenges associated with AS patients undergoing spinal surgery.

Main Methods:

• Awake fiberoptic endotracheal intubation for airway management.
• Infraclavicular approach for central venous access.
• Modified positioning techniques and neuraxial monitoring (SSEPs, tcMMEP) with spinal cord protection (hypothermia).
• Controlled hypotension and autotransfusion to manage blood loss.

Main Results:

• Successful airway management in most cases, with alternative techniques (cricothyroidectomy, retrograde intubation) used when necessary.
• Central venous access generally successful, with one instance of pneumothorax.
• One case of massive blood loss and transient loss of neurophysiological monitoring signals, with full recovery.
• Successful anesthetic management despite significant surgical and patient-related challenges.

Conclusions:

• Anesthetic management for AS patients undergoing TPV is highly challenging but can be successfully accomplished.
• Meticulous planning, anticipation of difficulties, and precise execution in airway management, vascular access, positioning, and bleeding control are crucial.
• Effective strategies for preventing neurological injury and massive hemorrhage are vital for positive outcomes.