Complications associated with lumbar laminectomy - A comparison of spinal versus general anesthesia

被引:44
作者
McLain, RF
Bell, GR
Kalfas, I
Tetzlaff, JE
Yoon, HJ
机构
[1] Cleveland Clin Fdn, Dept Orthopaed Surg, Cleveland, OH 44195 USA
[2] Cleveland Clin Fdn, Dept Neurosurg, Cleveland, OH 44195 USA
[3] Cleveland Clin Fdn, Dept Gen Anesthesia, Cleveland, OH 44195 USA
关键词
surgery; anesthesia; spinal anesthesia; complications; lumbar;
D O I
10.1097/01.brs.0000144834.43115.38
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. A case-controlled, comparative study of 400 patients undergoing lumbar surgery, treated with either spinal or general anesthesia. An independent observer analyzed outcomes. Objectives. To determine the rate and type of perioperative complications associated with each anesthetic method among lumbar surgery patients. Summary of Background Data. Spinal anesthesia is infrequently used for spinal procedures. While complications associated with spinal anesthesia are rare, some authors have suggested that spinal anesthesia may exacerbate existing neurologic disease and have recommended against its use in lumbar disc surgery. Others have found the technique safe and effective. General anesthesia may be preferred because it is seen as the routine accepted practice, because of greater patient acceptance and the ability to perform longer operations, or because of a general sense that general anesthesia is "safer" in these procedures. Methods. Patients treated between 1994 and 1998 were matched for anesthetic class, preoperative diagnosis, surgical procedure, and perioperative protocols. All patients were treated according to a uniform protocol and recovered in the same perianesthetic environment. Data from the intraoperative period through hospital discharge were collected and compared. Results. A total of 200 patients were included in each group. Overall complication rates and time to discharge were significantly lower in spinal anesthetic patients. Total anesthetic and operative times were significantly longer for general anesthetic patients, and perioperative heart rate and mean arterial pressures were elevated compared with those in spinal anesthetic patients. Nausea, requirements for antiemetic medication, and the incidence of urinary retention were significantly increased among general anesthesia patients. Spinal anesthesia patients had fewer spinal headaches compared with the general anesthetic group, but statistical significance was not obtained. Conclusions. For patients undergoing decompressive lumbar surgery, spinal anesthesia is at least comparable to general anesthetic with respect to complications. Specific advantages to spinal anesthesia include decreased nausea and antiemetic requirements, reduced analgesic requirements, and reduced overall complication rate.
引用
收藏
页码:2542 / 2547
页数:6
相关论文
共 28 条
  • [1] A PROSPECTIVE RANDOMIZED TRIAL COMPARING SPINAL-ANESTHESIA USING HYPERBARIC CINCHOCAINE WITH GENERAL-ANESTHESIA FOR LOWER-LIMB VASCULAR-SURGERY
    COOK, PT
    DAVIES, MJ
    CRONIN, KD
    MORAN, P
    [J]. ANAESTHESIA AND INTENSIVE CARE, 1986, 14 (04) : 373 - 380
  • [2] RATIONALE FOR SPINAL-ANESTHESIA
    COVINO, BG
    [J]. INTERNATIONAL ANESTHESIOLOGY CLINICS, 1989, 27 (01) : 8 - 12
  • [3] INFLUENCE OF SPINAL AND GENERAL-ANESTHESIA ON HEMOSTASIS DURING TOTAL HIP-ARTHROPLASTY
    DAVIS, FM
    MCDERMOTT, E
    HICKTON, C
    WELLS, E
    HEATON, DC
    LAURENSON, VG
    GILLESPIE, WJ
    FOATE, J
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 1987, 59 (05) : 561 - 571
  • [4] METABOLIC RESPONSE TO TOTAL HIP-ARTHROPLASTY UNDER HYPOBARIC SUBARACHNOID OR GENERAL-ANESTHESIA
    DAVIS, FM
    LAURENSON, VG
    LEWIS, J
    WELLS, JE
    GILLESPIE, WJ
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 1987, 59 (06) : 725 - 729
  • [5] LONG-TERM FOLLOW-UP OF PATIENTS WHO RECEIVED 10,098 SPINAL ANESTHETICS - FAILURE TO DISCOVER MAJOR NEUROLOGICAL SEQUELAE
    DRIPPS, RD
    VANDAM, LD
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1954, 156 (16): : 1486 - 1491
  • [6] Greenbarg P E, 1988, J Spinal Disord, V1, P139
  • [7] Hassi N, 1995, Cah Anesthesiol, V43, P21
  • [8] PROPOFOL-BASED ANESTHESIA AS COMPARED WITH STANDARD ANESTHETIC TECHNIQUES FOR MIDDLE-EAR SURGERY
    JELLISH, WS
    LEONETTI, JP
    MURDOCH, JR
    FOWLES, S
    [J]. JOURNAL OF CLINICAL ANESTHESIA, 1995, 7 (04) : 292 - 296
  • [9] A prospective randomized study comparing short- and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery
    Jellish, WS
    Thalji, Z
    Stevenson, K
    Shea, J
    [J]. ANESTHESIA AND ANALGESIA, 1996, 83 (03) : 559 - 564
  • [10] KEHLET H, 1984, CLIN ANAESTHESIOL, V2, P315