Major vertebral surgery: intra- and postoperative anaesthesia-related problems

A personal experience concerning vertebral excision and resection in a single stage for neoplasm is discussed. The surgery requires anaesthesia of long duration, hemodynamic stability, compensation of significant blood loss, monitoring of heat loss, maintenance without injury of prolonged prone position. Experience, with 24 cases lasting an average of 14.5 hours proves that inhalation or intravenous anaesthesia with a strong analgesic component is satisfactory. Normal heat saving systems reduce intraoperative hypothermia. Transfusion is always abundant, autologous contribution is moderate. Hemodilution is well-tolerated up to Hb 7%; below this amount there may be problems of a hemodynamic and coagulative nature. The quantity and quality of filling is guided by monitoring of pre-loading pressures and availability of oxygen. There were no critical complications; all of the patients left the hospital in good condition.