BIS-Guided Sedation Protocol for Awake Endoscopic Lumbar Surgery: Balancing Airway Safety and Neural Feedback Without...

Area of Science:

• Neurosurgery
• Anesthesiology
• Spine Surgery

Background:

• Endoscopic spine surgery is advancing, but concerns about dorsal root ganglion (DRG) injury hinder adoption.
• Awake surgery without general endotracheal anesthesia (GETA) allows real-time DRG feedback, avoiding general anesthesia risks.
• Maintaining optimal sedation is crucial for airway safety and patient comfort during awake procedures.

Purpose of the Study:

• To define a reproducible anesthetic protocol for awake endoscopic lumbar surgery.
• To establish Bispectral Index (BIS) targets for airway safety and DRG feedback.
• To avoid general endotracheal anesthesia (GETA) during endoscopic spine procedures.

Main Methods:

• Retrospective, case-matched cohort study.
• Compared awake endoscopic lumbar surgery (n=33) with minimally invasive surgery under GETA (n=32).
• Analyzed demographic, operative, anesthesia, and BIS data.

Main Results:

• No awake cases required conversion to GETA.
• Awake anesthesia used significantly lower propofol and opioid doses.
• BIS targets of 65±8 for TLIF and 70±4 for discectomy maintained sedation and airway patency.

Conclusions:

• The anesthetic protocol with BIS monitoring offers a reproducible method for awake endoscopic spine surgery without GETA.
• Reported BIS thresholds are exploratory and require multi-institutional validation.
• This approach facilitates DRG feedback and enhances patient safety.