At the 11th Annual Spine, Orthopedic & Pain-Management Driven ASC Conference on June 15, David Paly, MD, of NeoSpine in Seattle discussed best practices for anesthesia in outpatient spine surgery.
Dr. Paly has developed an anesthesia program that has proven very successful at his facility. He said that the smaller size of his practice allowed him some flexibility on which patients to accept for surgery, patients who might have been turned away elsewhere for their BMI, age or other characteristics or conditions, and to develop a program that quickens recovery times for all patients.
Before surgery, the charts and medication records are examined, and any issues are identified. “It’s really important to have preoperative nurses who have standardized set of orders review each chart enough in advance of the date of surgery, so that if anything needs to be done, it can be to reduce the risk of same day cancellation,” said Dr. Paly. This practice has allowed the surgery to achieve a near-zero rate of same-day cancellations for medical reasons.
Preoperative procedures: “I’m a strong believer in pre-emptive antiemetics,” said Dr. Paly. “I also give everyone a pre-operative oral pepcid, that dramatically increases stomach emptying,” to aid in reducing post-operative nausea, he said.
Perioperative procedures: “Preemptive antiemetics are critical” during surgery, said Dr. Paly. He also stressed the importance of preemptive analgesia. Local anesthesia should be administered before the first incision and at the end of surgery, he said. Additionally, he recommended 1 to 2 mg of morphine should be given during a bone graft harvest.
Postoperative procedures: Dr. Paly recommends minimizing IV infusions until the end of the case. “There’s nothing worse than a patient waking up with a full bladder,” he said. He also recommends using pressors and anti-hypertensives instead of crystalloids to ease the post-operative recovery process.