Index [] ·...

437 Index abdominal compression, 142, 289 accidental extubation, management of, 57 ACE inhibitors, 16 acetaminophen, 310–11, 336, 342, 427 achondroplasia, 180 acid–base derangements, mechanism of, 30 acidosis, 13 acid-sensitive ion channels (ASIC), 324 activities of daily living (ADL), 142 acute demyelinating lesions, 70 acute disc herniation, 71 acute disseminated encephalomyelitis (ADEM), 70 acute kidney injury, 285 acute normovolemic hemodilution (ANH), 46–7, 221, 361, 366 acute opioid tolerance (AOT), 343 acute postoperative hypertension (APH), 285 acute renal failure, 276 aſter myoglobinuria, 276 acute respiratory distress syndrome (ARDS), 211 acute transverse myelitis, 70–1 acute tubular necrosis, 285 adenosine, 324 adenosine triphosphate. See ATP adolescent idiopathic scoliosis (AIS), 196, 352 AIDS-related myelopathy, 71 airway anatomy, in humans, 208 airway edema, in spine cases, 56 airway exchange catheter (AEC), 210, 284 airway management, 240–1 for cervical spine surgery, 183 in patient undergoing spine surgery, 213 airway maneuvers, on cervical spine, 240 airway rescue maneuver, ASA algorithm for, 52 alar ligaments, 75, 229 albumin, 379 antithrombotic and anticoagulant effects, 31 and endothelial barrier function, 31 forms of, 31 glomerular filtration rate, 31 vs normal saline, 31 preparation of, 31 renal effects of, 31 Aldrete scoring system, 286 alfentanil, 109–10, 127, 198 EHL and CSHT, 109 Algorithm for Management of Acute Postoperative Hypertension, 286 allodynia, 324 allogeneic blood, 48 allogenic RBC transfusion, 220 and lumbar surgery, 220 all-or-none criterion, of CMAP response, 97 modification of, 97 alpha-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid (AMPA), 306 alpha motor neuron, 99 alpha-1 adrenergic blockers, 201 alpha-2 adrenergic agonists, 201 alprazolam, 342 alveolar ventilation, 322 American College of Surgeons (ACS), 172 American National Down Syndrome Society, 80 American Society of Anesthesiologists (ASA), 1, 222 algorithm for management of difficult airway, 52 guidelines for peripheral neuropathy management, 275 Task Force on Perioperative Blindness, 223, 268 Task Force on Prevention of Perioperative Neuropathies, 222 Visual loss registry, 16 American Society of Anesthesiology Postoperative Visual Loss (POVL) Registry, 219, 262–5 American Society of Neuroradiology, 63 American Spinal Injury Association (ASIA), 234 American Spinal Injury Association (ASIA) Impairment Scale, 235 aminocaproic acid (Eaca), 46, 221 amyotrophic lateral sclerosis, 71 anal sphincter, 101 analgesia, 110 Analysis of the Practice Advisory of the ASA, 1 Andrews frame, 218 anemia, 197, 220–3, 260–1, 264–5 anemia treatment protocol, preoperative, 45 anemia work-up for preoperative patients, 44 anemic patients, and blood management during surgery, 44 anesthesia arthogryposis, 418 and atrial septal defects (ASD), 406 and atrioventricular (AV) canal defects, 406 and cardiomyopathy, 411 Duchenne’s muscular dystrophy (DMD), 418 effect on evoked potential recordings, 126–8 heart transplantation, 410–11 Klippel–Feil syndrome, 417 management in cervical spine surgery, 184–5 and Marfan syndrome, 416 minimally invasive spinal surgery, 134 and Noonan’s syndrome, 417 Rett syndrome, 418 anesthetic agents, during surgery barbiturates, 108 benzodiazepine, 110 dexmedetomidine, 110 etomidate, 108–9 fentanyl, 109–10 inhaled, 107–8 ketamine, 110 and MEP monitoring, 107 propofol, 109 and SSEP monitoring, 107 anesthetic duration, 260, 264–6 anesthetic management, of acute SCI patients, 238–41 airway management, 240–1 airway maneuvers, 239 anesthetic plan, 239 in cases of difficult DL, 240 © in this web service Cambridge University Press Cambridge University Press 978-1-107-00531-0 - Anesthesia for Spine Surgery Ehab Farag Index More information

Transcript of Index [] ·...



abdominal compression, 142, 289accidental extubation, management

of, 57ACE inhibitors, 16acetaminophen, 310–11, 336, 342, 427achondroplasia, 180acid–base derangements, mechanism

of, 30acidosis, 13acid-sensitive ion channels (ASIC),

324activities of daily living (ADL), 142acute demyelinating lesions, 70acute disc herniation, 71acute disseminated encephalomyelitis

(ADEM), 70acute kidney injury, 285acute normovolemic hemodilution

(ANH), 46–7, 221, 361, 366acute opioid tolerance (AOT), 343acute postoperative hypertension

(APH), 285acute renal failure, 276

after myoglobinuria, 276acute respiratory distress syndrome

(ARDS), 211acute transverse myelitis, 70–1acute tubular necrosis, 285adenosine, 324adenosine triphosphate. See ATPadolescent idiopathic scoliosis (AIS),

196, 352AIDS-related myelopathy, 71airway anatomy, in humans, 208airway edema, in spine cases, 56airway exchange catheter (AEC), 210,

284airway management, 240–1

for cervical spine surgery, 183in patient undergoing spine

surgery, 213airway maneuvers, on cervical spine,

240airway rescue maneuver, ASA

algorithm for, 52alar ligaments, 75, 229albumin, 379

antithrombotic and anticoagulant effects, 31

and endothelial barrier function, 31

forms of, 31glomerular filtration rate, 31vs normal saline, 31preparation of, 31renal effects of, 31

Aldrete scoring system, 286alfentanil, 109–10, 127, 198

EHL and CSHT, 109Algorithm for Management of Acute

Postoperative Hypertension, 286allodynia, 324allogeneic blood, 48allogenic RBC transfusion, 220

and lumbar surgery, 220all-or-none criterion, of CMAP

response, 97modification of, 97

alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), 306

alpha motor neuron, 99alpha-1 adrenergic blockers, 201alpha-2 adrenergic agonists, 201alprazolam, 342alveolar ventilation, 322American College of Surgeons (ACS),

172American National Down Syndrome

Society, 80American Society of Anesthesiologists

(ASA), 1, 222algorithm for management of

difficult airway, 52guidelines for peripheral

neuropathy management, 275Task Force on Perioperative

Blindness, 223, 268Task Force on Prevention of

Perioperative Neuropathies, 222Visual loss registry, 16

American Society of Anesthesiology Postoperative Visual Loss (POVL) Registry, 219, 262–5

American Society of Neuroradiology, 63

American Spinal Injury Association (ASIA), 234

American Spinal Injury Association (ASIA) Impairment Scale, 235

aminocaproic acid (Eaca), 46, 221

amyotrophic lateral sclerosis, 71anal sphincter, 101analgesia, 110Analysis of the Practice Advisory of

the ASA, 1Andrews frame, 218anemia, 197, 220–3, 260–1, 264–5anemia treatment protocol,

preoperative, 45anemia work-up for preoperative

patients, 44anemic patients, and blood

management during surgery, 44anesthesia

arthogryposis, 418and atrial septal defects (ASD), 406and atrioventricular (AV) canal

defects, 406and cardiomyopathy, 411Duchenne’s muscular dystrophy

(DMD), 418effect on evoked potential

recordings, 126–8heart transplantation, 410–11Klippel–Feil syndrome, 417management in cervical spine

surgery, 184–5and Marfan syndrome, 416minimally invasive spinal surgery,

134and Noonan’s syndrome, 417Rett syndrome, 418

anesthetic agents, during surgery barbiturates, 108benzodiazepine, 110dexmedetomidine, 110etomidate, 108–9fentanyl, 109–10inhaled, 107–8ketamine, 110and MEP monitoring, 107propofol, 109and SSEP monitoring, 107

anesthetic duration, 260, 264–6anesthetic management, of acute SCI

patients, 238–41airway management, 240–1airway maneuvers, 239anesthetic plan, 239in cases of difficult DL, 240© in this web service Cambridge University Press

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consideration of risk factors, 239controlled intubation, 240manual in-line immobilization, 239neurologic evaluation, 239preoperative evaluation, 239radiologic evaluation, 239spinal movement, 239spine immobilization, 239–40surgical plan, 239surgical positioning, 241urgent intubation, 240

aneurysmal bone cysts, 248ankylosing spondylitis, 109, 210

related fractures, 121annulus fibrosis defect, 63

weakest point, 63anodal stimulation, 96anterior approach to thoracic spine

surgery, 159–61anterior atlanto-odontoid distance

(AAOD), 80anterior cervical discectomy (ACD),

5, 184, 273anterior cervical discectomy with

fusion (ACDF), 184, 298, 342anterior cervical pathology, 115anterior cervical surgery, 184

airway complications during, 117airway compromise management,

116cerebrospinal fluid leakage during,

116for cervical bone disruption, 113and C5 nerve root palsies, 117common type, 114and complication of retractor

migration blade, 116contraindication to cervical

extension, 115corticosteroids for, 115cuff pressure monitoring, 116epidural venous bleeding during,

116establishing spinal column stability,

116indications for, 113–14insertion of artificial disc, 115and neurological signs, 115overview, 114–15palpation monitoring, 116and period of hypotension, 115positioning of retractor

blades, 116postoperative mangement, 116–17preoperative management, 115for removing intervertebral discs,

114and retraction injury, 116

right-sided approach, 115and risk of injury to recurrent

laryngeal nerve, 115and risk of neurological

deterioration, 115surgical decompression procedure,

116surgical management, 115–16tissue edema, management of, 116transverse incision, 115for unstable spinal column, 113and use of SSEP and MEP, 115

anterior cord syndrome, 235anterior ischemic optic neuropathy

(AION), 222anterior lumbar interbody fusion

(ALIF), 131–2, 223anterior spinal artery syndrome, 199anterior spinal surgery, 125anterior T2–T12 vertebral levels,

surgery of, 159anterior/posterior hemivertebra, 349anterior–posterior cord compression

ratio, 182anterolateral spinothalamic tracts, 231antibiotic therapy, for surgery-related

infections, 171–2anticholine-esterase inhibitors, 288anticoagulants, 6anticonvulsants, 142, 305, 336, 342,

426antidepressants, 305, 322, 336antidromic stimulation of sensory

pathways, 95antiemetics, 58antifibrinolytic agents, 221antifibrinolytic treatments, for blood

loss reduction during surgery, 46antithrombotic therapy, 297anxiety, 336

post spine surgery, 307–8anxiolytic mediations, 322anxiolytic medications, 336aortic aneurysm, 199aortic clamping, 223aortic reconstruction, 223aortic stenosis, 11, 221aortic stent placement, 189AP projection, 144AP signaling and surgical outcome,

128aphasia, 201apical vertebra, 359apnea/hypopnea index (AHI), 14apophyseal joint ligamentous rupture,

77aprotinin, 221AQoL (Assessment of Quality of Life)

questionnaire, 149Arndt® Endobronchial Blocker, 206

Arnold–Chiari malformation, 181, 351, See also Chiari malformation type 1 (CM 1), 4, 7

treatment, 4Arnold–Chiari type II malformation,

350arrhythmias, 36, 196, 201, 365, 385,

406, 408, 410, 414, 417–18arterial hypotension, 222arterial systolic pressure variation, 35arteriovenous fistulas (AVF), 72–3,

223arteriovenous malformations (AVMs),

71–2intra-medullary, 72juvenile type, 73type I, 72type II, 72type III, 73type IV, 73

artery of Adamkiewicz, 158–9, 175arthrogryposis, 368arthrogryposis multiplex congenita,


advantage of, 115articular facets, of cervical vertebrae,

178articular pillar capsular ligaments, 75ASA Risk Score, 15ASIA impairment scale, 234asleep fiberoptic intubation, 56aspirin, 6astrocytomas, 81, 85, 164, 167, 247,

353ataxia, 71, 153, 336atelectasis, 4ATI, 355, 244atlanto-axial dissociation, 75atlanto-axial instability, 3, 180, 183,

354atlanto-axial joint, 180atlanto-axial subluxation, 66, 120

injury, 184atlanto-axis junction

ligamentous constraints, 229atlanto-dens interval, 229atlanto-dental interval, 180atlanto-occipital dislocation, 75atlanto-occipital extension, 19atlanto-occiptal instability, in

scoliosis, 80atlanto-occipital joint, 180atlas–axis junction, 229ATP, 303, 305, 324ATP-gated P2X4 channel (P2X4R),

305atrial natriuretic peptide (ANP), 27atrial septal defects (ASD), 3, 414, 416

anesthetic considerations, 406

anesthetic management, of acute SCI patients (cont.)© in this web service Cambridge University Press

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management, 406overview, 405

atrioventricular (AV) canal defects anesthetic considerations, 406management, 406overview, 406

atrophy, 153autoimmune diseases, 67autonomic dysreflexia, 20, 191, 200–1autonomic hyperreflexia (AH), 20,

285autonomic reflexes, 188autoregulatory capacity and SCI, 241avascular necrosis, 172aviation, 336awake fiberoptic intubation, 55–6

and muscle tone, 56awake fiberoptic intubation (AFOI),

240awake intubation, complicating

aspects of, 121axial compression fracture, 232axial T2*GRE, 77axonal reflex, 303Aβ-fibers, 303–4Aδ-fibers, 303–4

B2 receptor antagonists, 304Baastrup’s disease, 64Babinski and dissociated sensory loss,

153Babinski reflex, 200bacitracin, 172back pain, 216baclofen, 341banked allograft bone, 116“barber chair” phenomenon, 181barbiturate induction drugs, 108barbiturates, 169, 251basal IV PCA infusion, 332basal mean arterial pressure (MAP),

181benzodiazepines, 110, 169, 251, 287,

336benzomorphans, 308benzothiazole anticonvulsant, 244beta blockers, 190, 411bilateral disruption, 159bilateral laminectomy, 2, 140bilateral locked facets, 77bilateral pneumothorax, 190, 194bilevel positive airway pressure

(BiPAP), 15biplanar fluoroscopy, 144bispectral index, 385bisphosphonates, 144BiVent tube, 206bleeding dyscrasias, 171bleeding management, during

surgery, 46

blind nasal intubation, 56blood banking system, 48blood loss, in spine surgery, 28, 220–1blood management, during spine

surgery acute normovolemic hemodilution

(ANH), 46–7antifibrinolytic treatments, 46blood banking system, 48blood conservation in spine

surgery, 43of intraoperative coagulation, 48postoperative cell salvage, 48potential transfusion risks, 44preoperative autodonation (PAD),

46preoperative measures, 44–6recombinant activated factor VII,

46use of intraoperative red cell

salvage, 47–8blood pressure management, 264–6,

268blood transfusion, in surgery, 220blood, storage of, 47blunt trauma, radiologic evaluation

of, 231blurred vision, 153bolus doses of opioids, impact, 251bone filler device (BFD), 145bone grafts, 5, 114, 116, 140bone rongeurs, 116bone spur formation. See spondylosisbony bars/block vertebra, 80bowel obstruction, 175brachial plexopathy, 273–5, 277brachial plexus, 180

injury, 222bradyarrhythmias, 200bradycardia, 20, 190, 201, 313bradykinins (BK), 303–4, 324, 420brain abscesses, 69brain-derived neurotrophic factor

(BDNF), 305breast cancer, 248Brief Pain Inventory short form (BPI-

sf), 307bronchial blockers, 191, 194, 205–7,

213disadvantages, 205, 207

bronchoscope, 206bronchoscopic-guided tube

placement, 212bronchoscopy, 205bronchospasm, 110Brown–Sequard syndrome, 235Brucella genus, 67Bullard laryngoscope, 53

performance of, 54bupivacaine, 58, 312

burning dysethesia, 153burst fractures, 232butorphanol, 341butterfly vertebra, 80

C fibers, 303C1–2 injuries, 19C1–2 instability, 66C2 pars interarticularis, 76C2 vertebral body, displacement of, 76C2–3 disc space, 114C3 vertebral body, displacement of, 76C5 motor radiculopathy, 117C5 nerve root palsy, 117C7–T1 disc space, 114Ca(V)2.2 calcium channel, 307Ca2+/calmodulin-dependent protein

kinase (CaMKII), 307Café-au-lait spots, 368calcitonin, 144calcitonin gene-related peptide

(CGRP), 303–4, 324calcium, 144, 414calcium channel blockers, 201calcium pyrophosphate crystal

deposition disease, 67canal compromise, 182canal stenosis, 172cancers, 142

related fractures, 142capillary telangiectasias, 72capnography, 385carbon fiber cage, 114cardiac arrhythmias, 213, 285, 417cardiac auscultation, 11cardiac dysrhythmias, 201cardiac filling pressures and fluid

management, 32cardiac patient, for spinal surgery

antibiotics, 415defibrillators, 415echocardiogram, 414EKG, 414emergency drugs, 414history and physical examination,

412–13induction management, 414intraoperative management, 415lab tests, 413monitoring, 415with pacemakers, 414perioperative evaluation, 412–14

cardiac stenting, 190cardiac stress test, 197cardiac surgery, 220, 222cardiac vascular pressure (CVP), as

predictor of fluid responsiveness, 32–3, 35

cardiomyopathy anesthetic considerations, 411© in this web service Cambridge University Press

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management, 411overview, 411

cardiopulmonary insufficiency, 240cardiovascular disorder, 180cardiovascular examination, 1cardioverter-defibrillator, 411carotid dissection, 79case control study, 260, 265–6catastrophic neurological

deterioration, 119catastrophic traumatic airway injuries,

212catechol-O-methyltransferase, 333catelepsy, 110cauda equina syndrome, 248caudad displacement, 289caudal agenesis, 80caudal regression, 80cavernous angiomas, 72–3cefazolin, 154cell salvage, 221

complications with, 221intraoperative, 221recovery rate of RBCs, 221

cell savers, 47uses of, 48

cell transplantation therapies, 244cement extravastation, 144cement pulmonary embolism, 224central cavity creation procedures,

146central cord syndrome (CCS), 172,

183–4, 235central lumbar disc herniation, 131central nervous system (CNS)

monitoring, advanced neuropsychologic, 106central nervous system infections,

153central pain sensitization, 324central pain syndrome, 324central retinal artery occlusion, 222,

258–61, 263globe compression, 258, 260, 263

central sensitization, 306–7central venous pressure monitoring,

during PLIF, 139centrifuge bowls, 47cephalgia, 350cerebral hemorrhage, 201cerebral ischemia, 285cerebral meningitis, 68–9cerebral palsy, 7, 352cerebral vascular disease, 12cerebrospinal fluid (CSF)

drainage, 296leakage, 116, 174outflow, 4

cerebrovascular disease, 253

certified registered nurse anesthetists (CRNA), 1

cervical and elective surgery at lumbar level, 2, 9–13middle and lower levels, 2, 5–7thoracic levels, 7–9upper levels, 2–5

cervical arthoplasty, 115cervical collar, 115cervical cord

ischemic injury, 184lesions, 17

cervical disc herniation, 114cervical discectomy, 5

and coagulation profile, 7endotracheal tube (ETT) cuff

pressure, controlling of, 6precautions, 6preoperative pain control plan, 6and risk of damage to recurrent

laryngeal nerve, 6cervical kyphosis, 180cervical myelopathy, 119

beurologic symptoms, 181due to congential decrease in spinal

canal, 182due to cord compression, 182due to cord thickening, 182in elderly, 182gray matter changes, 182lateral columns, changes in, 182mechanism of, 182Nurick grading system, 182

cervical radiculopathy breast pain due to, 183due to degenerative changes, 181neurologic symptoms, 181

cervical ribs, 179cervical spine anatomy

anterior and posterior surfaces, 178anterior tubercle, 179artery and vein, 178articular facet, 178atlanto-axial joint, 180body, 178C1 atlas, 179C2 axis, 179C7 vertebra prominens, 179classification, 229foramen transversarium, 178inferior border, 178inferior facet, 178laminae, 178landmarks, 180lower surface, 178movement with intubation, 180–1movements of, 180pedicles, 178posterior tubercle, 179spinal nerve, 179

spinous process, 178superior facet, 178upper surface, 178

cervical spine fractures, 17cervical spine injury (SCI)

acute cases, 17–18anesthetic involvement, 19assesstment of risk for intubation,

19and cardiovascular system, 21clinical features, 18diagnosis and treatment, 18–20and gastrointestinal system, 21genitourinary system, 21and hematologic management, 21imaging of, 75immediate management of, 20incidence, 17, 231and mortality, 17musculoskeletal system, 21and respiratory system, 20–1and secured airway requirement, 19sports-related, 17surgical indications, 18and sympathetic response causes,

20cervical spine instability, 240cervical spine motion, determination

of, 54cervical spine surgery

airway management of, 183assessment of cervical

radiculopathy, 181–2and asthma, 185central cord syndrome (CCS),

183–4for cervical spondylosis, 181challenges, 181of chronic renal failure patients,

184complications in, 185and cord swelling, 185and cricoid pressure, 183and dysphagia complication, 185and esophageal perforation, 185indication for, 181induction and maintenance of

anesthesia, 184–5and intraoperative cervical cord

injury, 185mandibular protrusion, 181and MILS, 183neuro-intensive care after, 298–9and obesity, 185and pharyngeal perforation, 185preoperative assessment, 181for RA, 181risk factors, 185and RNL injury, 185upper airway assessment, 181

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vascular injury, 185cervical spondylosis, 80, 181

atypical presentations of, 183in elderly, 183intubation challenges, 184and ischemic heart disease, 183neurologic symptoms, 181

cervical spondylotic myelopathy, 119, 182

severity of, 182cervical stenosis, 119cervical trauma, 121cervical traumatic injury, 184cervical vascular injury, 79cervical vertebrae, 188Cethrin, 244C-fiber nociceptors, 303C-fibers, 307, 324Charcot–Marie–Tooth, 7CHARGE syndrome, 7chemical irritants, 303chemoprophylaxis, 298chemotherapeutic agents, 248chemotherapy, 8, 144, 164, 248Chest X-ray, 4Chiari II malformations, 79Chiari malformation. See Arnold–

Chiari malformationChiari malformation type 1 (CM 1),

152acquired form of, 153and advantages of endoscopic

technique, 154clinical manifestations, 153decompression of, 153electrophysiological monitoring

during surgery, 154endoscopic surgery of, 153female patients, surgical

considerations for, 154laminectomy, 155ocular symptoms, 153otoneurological symptoms, 153pathophysiology, 153patient positioning during

intubation, 153perioperative management, 153–5pressure management during

surgery, 153secondary form of, 153symptoms occuring from anterior

cord compression, 153and vision impairment, 153

chondroblastomas, 248chordomas, 3, 247–8chronic cervical cord compression,

184chronic fistula, 223chronic neck pain, case example, 342chronic obstructive pulmonary

disease (COPD), 171, 189, 194, 212

chronic pain management, 325in depression/anxiety patients, 341in elderly, 338–9in pediatrics, 338–9substance abuse patients, 339–41using spasticity devices, 341

chronic pain, post surgery anesthetic management, 325and anxiety, 322barriers to management of, 322challenges, 322as a disease, 322–4inadequate control of pain, 322predictors of, 321preoperative management, 324–6regional anethetic management,

326–30chronic progressive radiation

myelopathy (CPRM), 71chronic renal failure, 184chylothorax, 196circle of Willis, 185cirrhosis, 253cisplatin, 248cisplatinin, 248citalopram, 336claudication symptoms, 216clival chordomas, 2clonidine, 56, 201, 313, 336–7clopidogrel, 6closed spinal dysraphisms (CSD)

with a mass, 80without a mass, 80

closed spinal dysraphisms (CSD) without a mass

complex, 80CNS tumors, 85coagulation profile and thoracic spine

surgery, 189Cobb angle, 81, 351, 359codeine, 333Cohen® Flexitip Endobronchial

Blocker, 206collapsed IVC, 33colloids, 242, 260, 264–6

albumin, 31hydroxyethyl starch (HES), 31–2

colonoscopy, 2Combitube®, 54complications in spine surgery

bladder dysfunction, 175brachial plexopathy, 273–5, 277cardiopulmonary, 270cement leakage, 271cervicothoracic junction approach,

174coagulopathy, 271damage to lung apex, 174

death, 277dorsal and dorsolateral approaches,

175dorsal/ventral subaxial cervical

approach, 174durotomy, 175embolic, 271esopagus and trachea injuries, 174excessive blood loss, 271–3eye damage, 277hemorrhage, 174inadequate fluid resuscitation, 271infarctions, 275infections, 171–2from kneeling position, 174large vessel injury, 175from lateral position, 173life-threatening, 270–1lumbar sympathetic plexus injury,

175macroglossia, 275and malpractice claims, 277mediastinal injury, 174medical concerns, 277–8meralgia paresthetica, 275near cardiac collapse, 275nerve root injury, 174neuromuscular scoliosis, 276ophthalmic injuries, 276permanent brain damage, 277from positioning, 172–4, 273–6postoperative pancreatitis, 276–7preoperative risk assessment, 171from prone position, 173of pulmonary vasculature, 271rhabdomyolysis, 276from sitting position, 173–4SMA syndrome, 276–7steroid use in SCI, 172superficial wound complications,

270superior hypogastric plexus injury,

175from supine position, 173from surgical approaches, 174–5thoracic duct injury, 174thoracic spinal cord injury, 175in thoracotomy, 175tongue swelling, 174from transoral/lateral transcondylar

approach, 174vascular injury, 174ventral and dorsal approaches, 175visceral injury, 175wound, 271

compound muscle action potentials (CMAPs), 96–7, 220

and all-or-none criterion, 97and anesthesia, 98and body temperature, 98© in this web service Cambridge University Press

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factors affecting, 98and morphology criterion, 97and paralytics, 98TcMEP responses, 97–8and threshold criterion, 97unilateral dysfunction of motor

pathway, 97and variability in responses, 97

compression fractures, 232compression myelopathy, 71compression or wedge fracture, 77compressive myelopathy, 71computed tomography (CT), 143concomitant fractures, 75congenital cardiac disorders, 189congenital cervical stenosis, 184congenital deformities, 123congenital diaphragmatic hernia, 7congenital heart disease, 3congenital scoliosis, 348, 368congenitally abnormal bone

formation, 354congestive heart failure, 12, 253, 285Congress of Neurological Surgeons

(CNS), 172connective tissue disorders, 7controlled intubation, 240cord atrophy, 73–4cord compression, 66

injury, 233cord hemorrhage, 77, 79cord infarctions, 73cord injury, 18cord ischemia, 182cord transection, 78corneal abrasions, during PLIF, 139coronary artery disease, 221, 253coronary heart disease (CHD), 10corpectomy, 114, 116, 161, 194cortical blindness, 222, 260, 262cortical bone erosion, 67corticosteroids, 313, 338

for anterior cervical surgery, 115costotransversectomy, 162–3, 175craniocervical junction, 154, 181craniocervical subluxation, 66craniospinal axis disorders, 7craniovertebral junction (CVJ), 152,

154, 156creatine phosphokinase (CPK), 276creatinine clearance

and cardiac complications, 16and renal function, 17

cricoid cartilage, 180cricoid pressure, 183, 240cricothyrotomy kit, 19crystalloids, 29, 56, 223, 242, 260,

264–6, 375lactated ringers, 31

normal saline, 29–30C-spine injury, 19CT imaging, 68CT myelography, 68cuff leak test, 284–5cuffed endotracheal tube, 58Cushing syndrome, 142cyclic adenosine monophosphate

(cAMP), 308cyclo-oxygenase (COX) 2 inhibitors,

311, 428cytokines, 303–5, 307

dark marrow edema, 77decadron, 172decannulation of trachea, 3decompensated heart failure, 10decompressive surgery, 71deep tendon reflexes (DTRs), 18deep vein thrombosis (DVT), 9, 45,

58, 140–1, 190, 197, 307neuro-intensive care for, 297–8

deformities surgery, 123, 128degenerative diseases, 71

disc, 5, 216imaging studies of, 63–5spine, 175

degenerative disorders, 71degenerative endplate changes, 63degenerative facet disease, 64degenerative instability

(spondylolisthesis), 216degenerative spine diseases, 63delayed plantar response, 200delirium, 339, 341dementia, 253dermal sinus tract, 399, 402desflurane, 107–8, 169desflurane/remifentanil anesthesia,

110destructive spondyloarthropathy

(DSA), 184dexmedetomidine, 56, 107, 110, 198,

336–7dexmedetomidine sedation, 56dextrans, 378dextromethorphan, 306diabetes, 171, 250diabetes mellitus, 16diabetic nephropathy, 13diaphoresis, 336diarrhea, 336diastematomyelia, 123diastrophic dwarfism, 181diazepam, 110, 428diclofenac sodium, 311diffuse idiopathic skeletal hypertrophy

(DISH), 64–5dilated cardiomyopathy, 411dilators, 131dilutional acidosis, 30

diphenylheptanes, 308diplopia, 153direct laryngoscopic orotracheal

intubation, 54direct laryngoscopy (DL), 19, 180,

183–4, 239–40disc bulge, 63disc extrusions, 63disc herniation, 77, 106, 115, 130–1,

159, 181, 199, 299steroid therapy for, 172

disc protrusions, 63disk space infection, 66discectomy, 2, 114, 116, 161, 218, 271,

328discoligamentous complex (DLC), 229dislodgement of bone graft, 117dislodgement of fixation plate, 117distal inflatable balloon, 205distal sacral nerve root function, 234distended IVC, 33distorted tracheobronchial anatomy,

210distraction injuries, 234diuretics, 201dobutamine stress echocardiography

(DSE), 12accuracy of, 12vs stress myocardial perfusion

imaging, 13dopamine, 121Doppler-guided fluid bolusing, 32Doppler-guided fluid replacement, 32dorsal horn, 303

postsynaptic potential, 91dorsal root ganglia, 303, 305dorsolateral pons, 303double epidural catheters, 422–3double-lumen tube (DLT), 57, 204–9,

284advantages, 210application of CPAP, 210in an awake patient, 57basic design, 208and bronchial rupture, 212complications with, 212–13in difficult airway, 210–11exchange procedure, 57and failure of lung isolation, 212and hoarseness, 212for inflating tracheal portion, 208and injury from cuff, 212larger, 210materials used for, 208for one-lung ventilation, 211–12optimal size, 209in patients undergoing spine

surgery, 213softening technique, 57and sore throat, 212tracheal intubation and positioning

compound muscle action potentials (CMAPs) (cont.)© in this web service Cambridge University Press

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of patients, 208and tracheal laceration, 212tracheobronchial trauma, 212

double-lumen tubes left-sided, 208right-sided, 208

“Down lung” syndrome, 195Down syndrome, 3, 120, 180, 354

anesthetic considerations, 416atlantoaxial instability, risk of, 3and incidence of congenital heart

disease, 3lower blood pressures, risk of, 4overview, 416and spinal abnormalities, 80

down–slope time of the thermodilution curve (DStT), 34

drop metastases, 85droperidol, 169dual-energy X-ray absorptiometry

(DEXA) test, 8Duchenne’s muscular dystrophy

(DMD), 7, 353, 362, 421anesthetic considerations, 417overview, 417

duloxetine, 336dural arteriovenous fistula, 72dural puncture, 222duraplasty, 152durotomy, 175D-wave recordings, 98, 168, 220dysarthria, 153dysautonomia, 191dysmetria, 153dysphagia, 117, 153, 174dysphonia, 117dysphoria, 110dysraphisms, 79dysreflexia, 188dysrhythmias, 10, 13–14dystrophin, 353

edematous endplate changes, 64Ehler–Danlos syndrome, 7eicosinoids prostaglandins, 324elective lumbar spine procedures,

using spinal anesthesia, 58elective spine surgery, 120electrocautery elevation, 165electromyography (EMG), 89, 99, 123,

125, 191, 250during minimally invasive spinal

surgery, 133effect of neuromuscular blocking

agents, 101intensity of, 101intraoperative with SSEP

monitoring, 101limitations, 101measuring speed and bandpass, 99methodology, 99

of nerve root retraction, 101of neurotonic discharges, 100outcome, 101pedicle breach, 126and postoperative C5 palsies, 101selection of muscle, 99significant findings, 100–1simulation threshold, 126spontaneous, 126subcutaneous EEG needle

electrodes, 99and surgical manipulation, 126and tourniquet, 127triggered, 126of voluntary muscle contraction, 101

electrophysiologic monitoring, 123embryological development, of spine,

348–50emergency spine surgery, 17emergent thoracic spinal procedure,

198–201emphysema, 253end organ hypoperfusion, 219end/transitional vertebrae, 359endobronchial tubes, 205endocannabinoids, 324endocardial cushion defect, 3endocrinopathies, 142endoscopic anterior cervical

discectomy, 5endoscopic anterior lumbar interbody

fusion, 131endoscopic discectomy, 9endoscopic transforaminal technique,

130endoscopy, 9endothelial barrier function, 31endothelial glycocalyx (EG)

and albumin, 27causative factor of degradation of,

27and impermeability of arteriolar

and capillary domains, 26important functions, 27main constituents, 26mechanosensory role, 27in perioperative fluid management,

27role in binding and regulating

enzymes, 27role in maintaining vascular space,

26endothelial surface layer (ESL), 26endotracheal cuff pressure, during

anterior cervical surgery, 116endotracheal (ET) tube, placement

of, 180endotracheal intubation, 19endotracheal tubing, 115endovascular stent graft, 223enemas, 334

enflurane, 108, 169ependymomas, 2–3, 81, 85, 164, 167,

247–8, 353epidural abscess, 67–9, 71, 199, 222

predisposing conditions, 68epidural analgesia, 222epidural anesthesia, 421–2

adverse effects of catheters, 424double epidural catheter, 422–3infusion with local anesthesia,

423–4placement of catheter, 423

epidural catheter, 140, 221, 312for anterior spinal surgery, 222

epidural clonidine, 9epidural fluid, 77epidural hematoma, 79, 198, 222, 327epidural infusions, 222epidural PCA, 310epidural spinal cord compression

(ESCC), 248epidural venous bleeding, during

anterior cervical surgery, 116epiduroscopy, 130epinephrine, 296Epstein–Barr virus (EBV), 411EQ-5D (European Quality of Life-5

Dimensions scale), 149equianalgesic doses, 331Erb’s point potential (EP), 91erlotinib, 248erythropoetic stimulating agents

(ESA), 45use of, 45

erythropoietin-alpha, 221Eschmann stylet, 52esophageal Doppler technique, 37–8esophageal dysmotility, 174esophageal perforation, 117esophageal temperature probes, 57estimated blood loss, 260, 264–6estrogen, 144etomidate, 108–9, 127, 169EuroQol-5D questionnaire, 149evoked potential monitoring

approach. See motor evoked potentials (MEP) monitoring;;; somatosensory evoked potentials (SSEPs)

EVOS Functional Scale, 149extension of joint, 180extensor plantar reflexes, 3extracellular fluid (ECF), 372extracellular proteases, 324extradural neoplasms, 85extradural neurofibromas, 181extradural tumors, 247extrajunctional acetylcholine

receptors, 242extrapedicular approach, to VCF

management, 144© in this web service Cambridge University Press

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extravascular lung water (EVLW), 34extubation criteria, 283EZ-Blocker®, 206

face mask ventilation, 54facet arthropathy, 216facet effusions, 64facet hypertrophy, 64facet joint dislocation, 77facet joints, 229facial hypoesthesia, 153familial dysautonomia, 7fasciculus cuneatus, 89fatty endplate changes, 64fentanyl, 56, 101, 107, 109–10, 125,

127, 169, 198, 309, 312, 328, 332, 334, 342

and ester, 109EHL and CSHT, 109impact on evoked potential

recording, 109fentanyl patch, 248, 330fever, 336fiberoptic awake intubation, 121fiberoptic bronchoscopy, 55–6, 183,

206, 208, 210–11fiberoptic endoscope, 130fiberoptic intubation, 19, 55

and airway management, 183awake/asleep, 184

fiberoptic laryngoscopy, 120fiberoptic nasal intubation, 54fiberscope-guided tracheal intubation,

54fibrin, 221fibrinogen degradation, 221filum tumors, 84fine motor function, 153first-order neurons, 89flaccid paraparesis, 74flexible fiberoptic technique, 54flexion of cervical spine, 241flexion injuries, 233flexion of joint, 180flexion–extension, design of, 229flexion-teardrop fractures, 76flip and drip type systems, 48“floppy baby”’ syndrome, 7Floseal, 393FloTrac/Vigileo system, 34, 38flow time corrected (FTc), 37fluid management, during spine

surgery cardiac filling pressures, 32endothelial glycocalyx (EG).

See endothelial glycocalyx (EG)esophageal Doppler assessment

of aortic flow velocity/stroke volume, 37

factors influencing choice of fluid, 29

first limitation of using SVV, SPV, and PPV, 35–6

FloTrac/Vigileo system, 34intravenous fluids used in spine

surgery, 27–9measure of GEDV, 33–4normovolemia management, 25and pulmonary artery occlusion

pressure (PAOP), 33stroke volume variation and pulse

contour analysis, 35systolic and pulse pressure

variation, 34–5use of GDT, 37–8variables of fluid responsiveness,

34–7fluid management, pediatrics

and blood transfusion, 380–6body fluid content, 372–3BP monitoring, 384catheter monitoring, 384colloids, 377–9crystalloids, 377EKG parameters, 384electrolyte composition, 374–5and GFR, 373glucose requirement, 379–80guidelines, 382osmolality, 374–5osmotic regulation, 373peculiarities of pediatric

population, 372and renal system, 373sodium requirement, 379and temperature monitoring, 385and tissue perfusion, 380volume regulation, 374water requirements, 375–7

flumazenil, 288fluoroscopy, 159, 205fluoxetine, 336foam padding, 192focal cord ischemia, 71Fogarty occlusion embolectomy

catheter, 205Foley catheters, 154, 200, 401Foley’s tubular retractor, 131Fontan, 410foramen magnum, 106foraminal stenosis, 119, 130foraminotomy, 119Fpz electrode, 92fracture-dislocation, 106Frankel scale, 234Frank–Starling curve, 33Friedreich’s ataxia, 7, 71

anesthetic considerations, 417overview, 417

fundoscopic examination, 222, 258–62

fungal meningitis, 69

G protein-coupled receptors (GPCR), 324

gabapentin, 305, 311, 336, 426–7gacyclidine (GK-11), 243gag reflex, impaired, 153gait impairment, 142ganglioglioma, 82ganglioside GM-1 (Sygen), 243Gardner traction head holder, 192Gardner–Wells tongs, 173garlic, 6gastroesophageal reflux disease

(GERD), 366GCH1 (GTP cyclohydrolase 1), 308gelatins, 378general hospital consent, 1genitourinary disorder, 180giant cell tumors, 248gibbous formation, 68ginger, 6gingko, 6ginseng, 6Glasgow Coma Score, 231Glenn procedure, 409GlideScope, 19, 53–4, 56, 240gliomas, 247global end-diastolic volume (GEDV),

33–4glomus malformations, 72glossal atrophy, 153glossopharyngeal neuralgia, 153glottic structures, 53glottic visualization, of site of injury,

239gluconeogenesis, 31glutamate, 251, 303, 306–7, 324glutamatergic synapses, 306Goldenhar’s syndrome, 355G-protein-coupled receptors

(GPCRs), 304–5Gram-positive organisms, 172granulomatous spondylitis, 67–8gray matter, and cervical myelopathy,

182gurney, 57gustatory sweating, 196

halogenated agents, 124halogenated inhalational agents, effect

on EP recordings, 127, 169halothane, 108, 169hangman’s fracture, 75hard collars, 239headache-abortive medications, 342heart disease, 171heart transplantation

anesthetic considerations, 410–11management, 410overview, 410

hemangioblastoma, 82, 164hemangiomas, 8, 144, 147© in this web service Cambridge University Press

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hematocrit, 16, 127, 194, 221, 223hematoma, 71hemihypertrophy, 7hemilaminectomy, 216, 328hemimyeloceles, 79hemimyelomeningoceles, 79hemivertebra, 80, 349hemodynamic consequences, of

barbiturates, 108hemodynamic management, in

lumbar surgery, 219hemorrhage, 73, 174hemosiderin, 71hemothorax, 7herniated disc lumbar spinal stenosis,

134herniation of the disc, 63hespan, 379heterotrimeric G-proteins, 305hiatal hernia, 366high-intensity transient signals

(HITS), 271Hippel–Lindau syndrome, 82histamine, 324hoarseness, 117, 153hormonal therapy, 144Horner’s syndrome, 4, 116, 174, 183,

196horseshoe head holder, 192H-shaped gray matter, 231Hunter’s syndrome, 354hydrocephalus, 153hydrocodone, 333hydromorphone, 309, 342hydroxyethyl starch (HES), 31–2,

377–9effects on microcirculation, 31properties of, 31–2side effects, 32

5-hydroxytryptamine (HT), 324hyoid bone, 180hyperalgesia, 251hyperbaric bupivacaine, 58hyperbaric tetracaine, 58hypercalcemia, 21, 142, 197hypercapnia, 13, 351hypercarbia, 240hyperchloremic metabolic acidosis,

30–1hypercoagulability, 222hyperesthesia, 153hyperextension injuries, 17, 75, 183,


due to airway pressures, 241of neck, 241of spine, 241

hyperglycemia, 13, 16, 19hyperhidrosis, 189, 198hyperintense intramedullary lesion,

imaging of, 70

hyperkalemia, 21, 55hyperlipidemia, 11hyperreflexia, 3, 336hypertension, 11, 20, 250, 322hypertensive vasogenic edema, 18hyperthermia, 127, 201, 342, 385hyperthyroidism, 142hypertrophic cardiomyopathy, 411

and anesthesia, 411hypertrophy of facet joints, 64hypervolemia, 27hypoalbuminemia, 29hypoalgesia, 153hypocapnia, 220hypofibrinogenemia, 48hypoglycemia, 287hypogonadism, 142hypoplasia, 354hypoplastic left heart syndrome

(HLHS) anesthetic considerations, 410overview, 408–10

hyporeflexia, 153hypotension, 10, 18, 20–1, 35, 90, 121,

124, 159, 213, 220, 223, 259–61, 264–5, 286, 313

injury, 184and morphine, 309PACU care, 285–6

hypothermia, 21, 90, 124, 139, 190, 201, 220, 244, 385

hypotonia, 3hypoventilation, 322hypovolemia, 27, 32, 35, 110hypoxemia, 13, 127, 212–13, 351hypoxia, 3, 10, 18, 195–6, 220, 240

I wave recordings, 98idiopathic scoliosis (IS), 134, 193, 224,

307, 348, 351–2, 358–9idiopathic systemic disease, 65IL-1β, 304iliac crest, 140

grafting, 7imatinib, 248immune disorder, 71immunoglobulin G, 326impaired ionic homeostasis, 238implantable cardiac defibrillator

(ICD), 10, 414implants, 131inadequate postoperative pain

management, 322inadvertent extubation, management

of, 57infantile scoliosis, 351–2infection, associated with spinal

anesthesia, 326–7inferior facet, of cervical vertebrae,

178inferior vena cava (IVC), 218

inflammatory soup of signaling molecules, 324

inflatable balloon tamp (IBT), 144informed consent, 1inhaled anesthetic agents, 107–8insomnia, 9interbody spacers, 141intercostal arteries, 188intercostal EMG monitoring, 104intercostal neuralgia, 161interleukin-1β (IL-1β), 324internal disc herniations, 65interspinous ligament, 75intervention failure, of regional

anesthesia, 328intervertebral bone graft, 140intervertebral disc, 229intervertebral osteophyte formation,

113intracellular fluid (ICF), 372intracranial aneurysms, 72intradural extramedullary tumors,

248intradural tumors, 216intramedullary abscess, 69intramedullary AVMs, 72intramedullary gliomas, 248intramedullary hemorrhage of spinal

cord, 78intramedullary neoplasms

astrocytomas, 81ependymoma, 81ganglioglioma, 82hemangioblastoma, 82metastasis, 82

intramedullary spinal cord arteriovenous malformations, 71

intramedullary spinal cord tumors evidence for resection, 164location of, 164

intramedullary tumor resection anesthesia, considerations for, 169baseline electrophysiological

recordings, 165and biopsy of tumor, 166dissection of ventral surface, 167drainage of cyst, 166electrocautery elevation, 165EP monitoring of, 164intraoperative electrophysiological

monitoring, 167–8locating the tumor, 166midline myelotomy, 166perioperative management, 165preopertive MRI, 166recovery of lost/diminshed

potentials, 168–9and SSEP, 167subperiosteal elevation, 165surgical technique, 164–7© in this web service Cambridge University Press

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intramedullary tumors, 247–8intramural and intramedullary

metastases, 8intraoperative bupivacaine

infiltration, 329intraoperative cell salvage, 221

role in blood loss management, 47–8

intraoperative coagulation disorders, during spine surgery, management of, 48

intraoperative electrophysiological monitoring

during anterior cervical surgery, 115

role in intramedullary tumor resection, 167–8

intraoperative fluid management, 29optimisation strategy, 32

intraoperative goal-directed fluid therapy (GDT), 37–8

intraoperative neurophysiologic monitoring

and correction of large idiopathic curves, 123

in deformities surgery, 123during anterior and posterior

surgery, 123effect of anesthesia on recordings,

126–8effect of body temperature, 127impact on surgical outcome, 128indications for, 123–4in lumbar surgery, 123in thoracic spine surgery, 123

intrathecal baclofen withdrawal syndrome, 342

intrathecal catheter placement, 222intrathecal (IT) morphine for

postoperative pain control, 425–6

intrathecal pain pump, 217intrathoracic blood volume (ITBV),

34intrathoracic thermal volume (ITTV),

33intratumoral cysts, 81intravenous iron supplementation,

45–6intravenous ketamine, 337intravenous patient-controlled

analgesia (IVPCA), 309–10, 312, 332, 342, 426

intravenous steroids, 223intrinsic ligamentous abnormality,

180intubating laryngeal mask airway

(ILMA), 57, 183Intubation Difficulty Scale (IDS), 52invasive costotransversectomy, 159

inversion recovery (STIR or IR) sequences.(metastasis illustration) T1 signal, 61

ion channels, 305ionotropic glutamate receptors, 306ipsilateral fasciculus gracilis, 89ipsilateral palsy, 183iron dextran, 45ischemic cervical injury, 241ischemic heart disease, 12ischemic optic neuropathy (ION),

173, 191, 219, 222, 258–67anterior, 222factors responsible for, 222incidence rate, 222posterior, 222risk factors, 266systemic vascular risk factor, 222treatment, 223

isoflurane, 108–9, 169iso-oncotic colloids, 29isotonic crystalloids, 27IV discharge readiness, 286–8

Jackson frame table, 191, 193Jackson table, 218–20, 389Jamshidi needle, 131Jarcho–Levin Syndrome, 368Jefferson fracture, 75Jeune Syndrome, 368junctional kyphosis, 390

K+ currents, 324kainite receptors, 30612.4-kDa basic protein, 305keratan sulfate, 354ketamine, 56, 110, 127, 169, 252, 337,

343hemodynamic stability using, 110

ketoprofen, 311ketorolac, 308, 310–11, 335, 395, 428Klippel–Feil deformity, 181Klippel–Feil syndrome, 180, 354, 368

anesthetic considerations, 417overview, 417

Klippel–Feil variant, 180Kv7 channels, 305kyphoplasty, 8–9, 134, 144–5, 188, 271

anesthesia management, 198and cardiac condition, 197cement infusion, 196and cement leak, 198cement pulmonary embolism, 224complications, 147, 198contraindications, 196formation of internal cast, 224intraoperative considerations,

197–8opioid boluses for, 198patient positioning, 198

using PMMA, 148postoperative considerations, 198preoperative evaluation, 197and pulmonary system, 197steroid use, 198and vertebral body, 196

kyphoscoliotic deformities, 159kyphosis, 7, 142, 175, 354

minimally invasive spinal surgery for, 134

L1–L2 junction, 231lactated Ringers, 31laminectomy, 1–2, 9, 16, 20, 113,

119–20, 152, 161, 165, 190, 216–18, 271, 328

indication for, 113lateral extracavitary approach, 163midline approach, 162posterolateral approach, 162risk factors, 162transpdicular approach, 162

laminoforaminotomy, 119–20laminoplasty, 119

for spondylotic myelopathy, 120large vessel injury, 175laryngeal edema, 283laryngeal mask airway (LMA), 52,

54, 183laryngoscopy, 52–3, 181lateral columns, and cervical

myelopathy, 182lateral hemivertebra, 349lateral lumbar interbody fusion

(LLIF), 131, 133law of electroneutrality, 30laxatives, 334left ventricular end-diastolic area

(LVEDA), 33leptomeninges, 65leukodepletion filters, 48leukoplakia, 14leukotrienes (LTs), 304, 324levobupivacaine, 329Lhermitte’s sign, 115, 181LidCO system, 33–4lidocaine, 127, 328ligamentous injury, 77ligamentous laxity, 3ligamentum flava, 75lighted stylet, 56limb movement assessment, 287limbic encephalitis, 71lipid peroxidation, 238lipomeningocele, 399, 401lipomyelocele placode–lipoma

interface, 80lipomyeloceles, 80lipomyelomeningoceles, 80lipooxigenase enzyme, 304© in this web service Cambridge University Press

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lobectomies, 189longitudinal bolster, 218longus colli muscle, 116lorazepam, 342low threshold interneurons, 303lumbar decompression

pain post, 307lumbar disc arthroplasty, 223lumbar discectomy, 223, 307lumbar fusion, 2lumbar laminectomy, 58lumbar level, elective surgery at, 9–13lumbar potential (LP), 92lumbar spine, 66, 68lumbar spondylolithesis, 138lumbar surgery

and allogenic RBC transfusion, 220and anesthesiologists, 10assessment of blood pressure, 11assessment of cardiac condition,

11–12assessment of hematologic

disorders, 16assessment of preoperative risk, 11blood loss and transfusion, 220–1blood loss reduction strategy, 221blood pressure management, 219and consent issues, 17deformity correction, 217in degenerative conditions of spine,

216and diabetes mellitus, 16and drug interactions, 16and effect of smoking, 13–14and forms of embolism, 223–4goal of positioning, 218hemodynamic management, 219and history of cardiac conditions,

10and history of medication, 10importance of physical

examination, 11and independent risk factors, 12intraoperative management, 218and ischemic complications, 219kneeling position, 219lateral position, 218lumbar radiculopathy, 216for lumbar stenosis, 216for metastatic disease, 217neuro-intensive care, 300perioperative neuropathy, 222postoperative pain management,

222and postoperative vision loss,

222–3and preoperative creatinine levels,

16and preoperative evaluation of

patients who cannot exercise, 12

preoperative management, 217–18and presence of pathological Q

wave, 11for primary bony tumors, 217for primary tumors, 217and prone position, 218and pulmonary hypertension,

15–16for radiculopathy, 216regional anesthesia, 218and renal impairment, 16retraction of iliac veins, 219and review of ECG, 11–12and risk of obesity, 14–15and risk of perioperative

respiratory complications, 13–14sedation administration, 218skill of anesthesiologist, 216supine position, 218and thromboembolism, 219traumatic injuries, 217tumors, 217use of intraoperative monitoring,

219–20use of muscle relaxants, 220utility of cardiology consultations,

10–13and vascular injuries, 223wake-up test, 220and wasting of predonated

autologous blood, 221lung cancer, 248lung compressive atelectasis, 212lung isolation, for thoracic spine

surgery bronchial blockade, 205–7endobronchial tubes, 205equipment and techniques, 205–7using double-lumen tubes, 208–13

lung recruitment maneuvers, 213lymphomas, 248lysine analogs, 46, 221

M channels, 304MAC 3 blade, 183Macintosh and Miller laryngoscopes,

52, 54–5, 56macroglossia, 275, 283magnesium, 337male sex, 260, 264–6malnutrition, 142, 171mammography, 2mandible bone, 180mannitol, 223manual in-line immobilization

(MILI), 239manual in-line stabilization (MILS),

183manubrium, opening procedure of,


Marfan syndrome, 7, 368anesthetic considerations, 416overview, 416

marrow replacement process, 61marrow signal abnormalities,

evaluation of, 61mask ventilation, 54, 57Mayfield head holder, 119, 154, 165,

173, 184, 192–3, 223McCoy laryngoscope, 53–4McGrath video laryngoscope, 53MDCT (multidetector CT) technique,

75mean arterial pressures (MAPs), 231mean pulmonary artery pressure

(mPAP), 16MECP2 gene abnormality, 368medulloblastoma, 85meningeal inflammation, 67meningiomas, 84, 247–8meningitis, 68–9meningoceles, 80, 350, 399, 402meperidine, 336meralagia paresthetica, 275Merckel cells, 303metabolic disorders, 71metabotropic glutamate receptors, 306metabotropics, 306metastasis, 61, 67, 71, 82metastatic bone lesions, 142metastatic cancers, 142, 248metastatic lung cancers, 189metastatic renal cell carcinoma, 189metastatic spine tumors, 164metformin, 31methadone, 333, 337methohexital, 108methylmethacrylate, 5methylnaltrexone, 334methylprednisolone (MP), 19, 243,

313, 329, 338microcirculatory dysfunction, 238,

241microdiscectomy, 131, 216, 328midazolam, 56, 101, 110, 198middle lower cervical spine, surgery

at, 2milnacipran, 336minimally invasive single level

laminectomy, 1minimally invasive spinal surgery

ALIF, 132anesthetic conditions, 134blood loss management, 134conditions treated with, 134for deformity, 134and EMG monitoring, 133endoscopic anterior lumbar

interbody fusion, 131epiduroscopy, 130© in this web service Cambridge University Press

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general principles, 130of kyphosis, 134LLIF, 133PLIF, 132of scoliosis, 134TLIF, 132for trauma, 134for tumors, 134using pedicle screw

instrumentation, 131–2using tubular retractor, 131with working channel spinal

endoscopes, 130mixed edema and hemorrhage, 77Modified Aldrete and Post Anesthetic

Discharge Scoring System, 287monoamine oxidase inhibitors

(MAOIs), 201, 336monopolar electrode, 126morphine, 308, 313, 329, 335, 338Morquio’s syndrome, 181motor deficits, monitoring of.

See motor evoked potentials (MEP) monitoring

motor evoked potentials (MEP) monitoring, 89, 107, 123, 125, 241, 250, 389

all-or-none criterion, 97amplitude criterion, 125and anesthesia, 98in anesthetized patients, 95anodal stimulation, 95in awake subjects, 95background, 94–5and body temperature, 98and choice of anesthetic agents, 107CMAPs, 96–7D waves, 95desflurane/remifentanil anesthesia,

110direct and indirect waves, 98during anterior cervical surgery,

115during anterior spinal surgery, 125effect of volatile anesthetic agents,

127false-positive rates, 99interpretation of, 125intramedullary tumor resection,

164and ketamine, 110magnetic vs electric stmulation, 95methodology, 95–7of motor cortex, 168of muscle disappearance, 168myogenic, 95, 97neurogenic, 95, 97opioid effect, 127outcomes, 98–9

and paralytics, 98from peripheral nerves, 97positive and negative predictive

values, 99of primary cortex, 95purpose of, 95role in neuromonitoring, 95sensitivity and specificity, 99significant findings, 97–8single-pulse stimulation technique,

95spinal simulations, 95threshold criterion, 125transcranial, 95, 125transcranial stimulation of motor

cortex, 95, 97of traumatic spinal cord injury, 95,

241types of, 95via direct spinal cord stimulation,

96warning criteria, 98

Mu receptor agonists, 308mucopolysaccharidosis, 368mucopolysaccharidosis IV, 181multilevel lumbar decompressive

laminectomy, 335multimodal analgesia, 308multimodality intraoperative

monitoring (MIOM), 126multimodality neuromonitoring

techniques, 216multiple lumbar punctures, 153multiple myeloma, 142multiple sclerosis, 71, 324muscle atrophy, 153muscle hypotonia, 3muscle MEP responses, 168muscle relaxants, 220, 287muscles of respiration, 242muscular dystrophy, 7Mycobacterium tuberculosis, 67myelinated fibers, 303myelitis, 69myelodysplasia, 61, 350myelography, 68myelomeningoceles, 79, 350, 398–9,

401myelopathy, 66, 69, 71, 117, 119myocardial infarction, 196, 322myocardial ischemia, 13–15, 285, 322myoclonus, 336myogenic MEPs, 96–7myogenic motor evoked potentials, 97myoglobinuria, 276myotomes, 99, 348myxopapillary ependymomas, 84

N13 wave form, 91N18 wave form, 92N20 wave form, 92

N34 wave form, 92nalbuphine, 341, 428naloxone, 243, 288, 341, 429naltrexone, 341naproxen, 311nasal CPAP (nCPAP), 14nasopharyngeal carcinoma, 71National Acute Spinal Cord Injury

Study (NASCIS), 19, 172, 243nationwide inpatient sample, 263,

266–7neck hematoma management, 283neck movement, and intubation in

patients with spine instabilty, 54necrosis of skeletal muscle, 276needle electrodes, 126neostigmine methylsulphate, 338nerve growth factor (NGF) , 305, 324nerve roots

compression, 119, 354entrapment, 106

nerve sheath tumors, 247neuralgia, 196neuraxial opioids, 328neurenteric cyst, 80neuraxial analgesia, 312–13neuraxial blocks, 326neurofibromas, 84, 247neurofibromatosis, 7, 368neurofibromatosis Type 1 (NF1), 180neuroforamina, 64neuroforaminal stenosis, 63neurogenic inflammation, 303neurogenic MEPs, 97neurogenic shock, 121, 242neuro-intensive care unit

after cervical spine surgery, 298–9after lumbar surgery, 300for DVT, 297–8perioperative blood transfusions,

297for spinal cord ischemia, 295–6for thoracic spine surgery, 299–300

neurokinin A, 303neurokinins, 303neurologic assessment, 294–5neurologic assessment, of traumatic

spinal cord injury (SCI), 234neurologic dysfunction, 175neurologic injury, during tracheal

intubation, 54neurologic pathology, abnormal, of

pediatrics, 352–3neuromuscular blocking agents, 107,

341effect on EP recordings, 127in MIS, 134

neuromuscular scoliosis (NMS), 276, 362–7

neuronal injury, 238neurophysiologic intraoperative

minimally invasive spinal surgery (cont.)© in this web service Cambridge University Press

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monitoring (NIOM), 89neurophysiologic monitoring, of

spinal cord, 106neurosurgery and nerve injury, 222neurotransmitter-induced

neurotoxicity, 238neurotropic growth factor (NGF), 305neurotropin-3, 305neurotropin-4/5, 305neutropenia, 197nicotine and bone metabolism, 6nicotine patches, 337, 341nifedipine, 201nimodipine, 243Nissen fundoplication, 367nitric oxide, 305, 307nitrous oxide, 108, 124, 127, 169, 191,

195NK (neurokinin) modulator, 305N-methyl-d-aspartate (NMDA)

receptor, 306, 324nociceptive-specific neurons, 303nociceptors, 302Nomenclature and Classification of

Lumbar Disc Pathology, 63nondepolarizing muscle relaxants, 107non-NDMA receptors, 306nonprogressive neuromuscular

disability, 352nonsteroidal anti-inflammatory drugs

(NSAIDs), 5, 308, 310–1, 325, 334, 342, 427–8

nonterminal myelocystoceles, 80Noonan’s syndrome

anesthetic considerations, 417overview, 417

norepinephrine, 121normal spine imaging studies, 61–3North American Spine Society

(NASS), 63, 172N-phenylpropanamide, 309numerical rating scale (NRS), 150Nurick grading system, 182nystagmus, 153

obese patients perioperative complications, 14postoperative complications, 14

obesity, 260, 263, 265–6obstructive sleep apnea, 194obstructive sleep apnea syndrome

(OSAS), 14–15obtundation, 18occipital-cervical surgery, 119occipito-atlanto-axial disease, 181occipito-atlas junction, 229odontoid fractures, 2, 75odontoid process, 179–80olfactory ensheathing cells, 244oligodendrogliomas, 247omeprazole, 342

one-lung ventilation and blood flow, 212management of, 211–12and tracheobronchial trauma, 212

open microdiscectomy, 130open thoracic spine surgery

acute hemodynamic changes, 191and airway edema, 192airway examination, 189anesthesia technique, 191anterior approach to, 190antibiotic administration, 191and anticoagulants, 190and antiplatelets, 190assessment of medical history, 190and beta blockers, 190blood pressure monitoring, 190cardiac involvement, 189care in PACU, 192and chemosis, 193chest radiographs, 189coagulation profile, 189complications, 193and conjuctival swelling, 193electrophysiologic monitoring, 190endotracheal tube leak test, 192epidural analgesia, use of, 192estimation of fluid status, 190and facial swelling, 193hemodynamic monitoring, 190hemodynamic stability, 191and hypoperfusion of spinal cord,

191and hypothermia, 190and injury to adjacent organs, 190intraoperative considerations,

190–2intraoperative neurophysiologic

monitoring, 190intraoperative placement of

epidural catheter, 191need for cardiology consultation,

189neuromonitoring, 191and nitrous oxide, 191operating table, 191and opioids, 191padding of pressure points, 192patient history and activity level,

189patient position, 192physical status classification, 190positioning of head, 192posterior approach, 190postoperative considerations, 192preoperative evaluation, 189–90prone position of patient, 192

and risk for intraoperative hemorrhage, 190

pulmonary involvement, 189renal function testing, 189

rescue management, 192risk of infections, 193skeletal involvement, 189and skin abrasions, 193standardized laboratory testing, 189sympathectomy, 192temperature monitoring, 190and wake-up test, 190

open thoracotomy, 134opioid agents, 322, 341

antagonists, 334challenges with, 332conversion and rotation, 332–3delivery systems, 333–4equianalgesic dosage of, 331and genetic variability, 333patient monitoring, 334postoperative use, 331–2preoperative and intraoperative

dosing, 330–1and SSEP, 169use disorders, 323

opioid receptor antagonists, 334opioid therapy, 308–10opioid-based analgesia, 308opioid-induced hyperalgesia (OIH),

326, 343opioid-induced respiratory

depression, 322optic nerve circulation, abnormal

autoregulation of, 222oral cancers, 14oral gastric tubes, 57organ hypoperfusion, in prone spine

surgery, 29orthopedic surgery and nerve injury,

222oscillopsia, 153osseous injury, 79ossification of the posterior

longitudinal ligament (OPLL), imaging of, 64

osteoblastic lesions, 142osteoblastomas, 248osteochodromas, 248osteochondrosis of the thoracic spine,

65osteogenesis imperfecta, 181osteoid osteomas, 248osteoligamentous columns, 75osteomyelitis, 66, 159, 299osteophytes, 182–3osteoporosis, 8, 21, 142–4, 147, 196

demography of population affected with, 8

osteoporotic vertebral fractures, 9and pulmonary function, 9risk factors, 8

osteoporotic fractures, 142Oswestry Back Disability Index, 149oxycodone, 309, 333–4, 342, 428© in this web service Cambridge University Press

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P14 wave form, 91P37 wave form, 92PACU care

abdominal compression, 289acute postoperative hypertension

(APH), 285airway management, 283for airway obstruction, 282autonomic hyperreflexia, 285backache, 288brachial plexus injuries, 289breast injuries, 289of cuff leak, 285disachrage readiness, 286–8for hypotension, 285–6hypoventilation, 282hypoxemia, 282ischemic necrosis, 288neck, 289neck hematoma, 283oxygen supplementation, 282pressure alopecia, 288for prone position injuries, 289use of airway exchange catheters,

284use of opioids, 282

pain acute, physiology, 302–7defined, 302neuraxial analgesia technique for,

312–13nociceptors of, 308opioid therapy, 308–10post-spine surgery, 307–8postoperative, 420

pain-related sympathetic stimulation, 322

Papworth BiVent Endotracheal Tube®, 206

para-coccygeal incision, 134paraparesis, 159paraplegia, 159, 198paraspinous abscesses, 67–9paraspinous muscles, 162parecoxib, 311, 335paroxetine, 336patient-controlled analgesia (PCA),

192, 221, 342pediatric solid tumors, 142pediatric spinal cord tumors, 353pediatric traumatic SCI, 353–4pedicle fractures, 77pedicle screw placements, monitoring

of. See triggered EMG monitoring

pedicle screw stabilization, 2pedicle screw stimulation.

See triggered EMG monitoringPentax-AWS, 53–4pentazocine, 341

peptidergic C-nociceptors, 305percutaneous discectomy, 130percutaneous pedicle screws, 131–2percutaneous vertebroplasty, 196, 224peri-facet bupivacaine infiltration, 329periglottic areas, 243perioperative antifibrinolytic agents,

221perioperative cardiac risks, 13perioperative fluid management, 27perioperative hemodynamic stability

and spinal anesthesia, 58perioperative intravenous steroids, 56perioperative neuropathy, 222perioperative peripheral nerve injury,

222perioperative visual loss, 173peripheral edema, 11peripheral nociceptive sensory

neurons, 303peripheral sensory nociceptors, 306–7permissive hypercapnea, 211pertinent medical records, 1pharyngeal edema, 116, 283phenanthrenes, 308phenelzine, 336phenylephrine, 414phenylpiperidines, 308Philadelphia collar, 55phosphenes, 153photophobia, 153physical trauma, 7PiCCO system, 33, 35piloerection, 201pineal neoplasms, 85PKB/Akt, 307placode–lipoma morphology, 80plasma-derived albumin, 29pleural tear, 175pneumonectomy, 197pneumonia, 175, 322pneumothorax, 7, 196, 213PO iron, 45Poisson effect, 182, 241polycythemia, 17polymethylmethacrylate (PMMA), 8,

196, 224polyvinyl chloride (PVC)

endotracheal tube, 52popliteal fossa potential (PF), 92poryphyria, 108positioning injuries, 273–6positive pressure ventilation (PPV), 58postoperative epidural hematoma, 199Postoperative visual loss (POVL),

257–69postoperative wound infection,

antibiotic therapy for, 171–2posttransplant lymphoproliferative

disorder (PTLD), 411

PostAnesthetic Discharge Scoring System, 286

posterior approach, to thoracic spine surgery, 161–3

posterior atlanto-dens interval, 229posterior cervical decompression, 275posterior cervical spine surgery

anesthetic considerations, 120blood pressure monitoring, 120common principles, 119elective interventions, 120–1fiberoptic awake intubation, 121fiberoptic intubation, 119–20hemodynamic state, management

of, 121and hypotension, 121indications for, 118–19intubation procedure, 119laminectomy, 119laminoplasty, 119midline incision, 119of patients with rheumatoid

disease, 120patient positiong, 119–20traumatic interventions, 121use of foam pillow, 119and vision loss, 121

posterior columns, 231distraction, 233

posterior cord syndrome, 235posterior fossa lesions, 153posterior fossa surgery, 275posterior ischemic optic neuropathy

(PION), 222posterior ligamentous complex, 75,

233posterior lumbar interbody fusion

(PLIF), 132airway management, 139attention to hemostasis, 140blood loss management, 139complications, 141contraindications, 138and corneal abrasions, 139hardware complications, 141and hypothermia, 139indications, 139–40inspection of nerve root foramina,

140long-term complications, 141midline incision, procedure for, 140monitoring of blood pressure, 139and NSAIDs, 311placement of pedicle screws, 140positioning and patient

preparation, 140postoperative care, 140postoperative neuralgia, 141procedural complications, 141prone positioning of patient, 139© in this web service Cambridge University Press

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and pseudoarthrosis, 141and recurrent lumbar disc

herniation, 138subperiosteal exposure of lumbar

spine, 140surgical decompression, 140surgical procedure, 140use of body warmers, 139vascular injury, 223

posterior spinal arthrodesis, 330posterior tubercle, 179posterolateral corticospinal tracts, 231posterolateral fusions, 2postlaminectomy kyphosis, 119postoperative acute pain, after spine

surgery, 307–8postoperative analgesia, 253postoperative arachnoiditis, 71postoperative computed tomography

(CT), 104postoperative epidural analgesia,

221–2postoperative hypoventilation, 282postoperative hypoxemia, 282postoperative intercoastal neuralgia,

196postoperative management, of

anterior cervical surgery, 116–17postoperative opioid management,

331–2postoperative pain management, 1,

222postoperative pancreatitis, 276–7postoperative radiation therapy, 248postoperative venous

thrombosis, 219postoperative vision loss (POVL),

222–3potassium, 169Pott’s disease, 8Powers ratio, 229Prader–Willi syndrome, 7prazocin, 201preanesthetic evaluation, 1pre-donated autologous blood, 221preemptive analgesia, 325preemptive infiltration, 329pregabalin, 305, 312, 336preoperative risk assessment, of spine

surgery, 171preoperative assessment of adult

patients advisory group, 1general guidelines, 1–2obtaining history and physical

examination, 1preanesthetic evaluation, 1routine testing, 2site of surgery, 2–3sources of information, 1

preoperative autodonation (PAD), 46preoperative autologous blood

donation, 221preoperative autologous donation, 221preoperative evaluation, of pediatric

patients arterial oxygen tension, 360blood pressure, 360cardiac condition, 361, 365Cobb angle, 359congenital syndromes, 367–9ethical considerations, 367gastrointestinal, 366general evaluation, 359hematologic ocndition, 365–6idiopathic scoliosis, 359–2neurologic, 367neuromuscular scoliosis, 362–7nutritional status, 366of pulmonary functions, 363–5seizures, 367

preoperative measures, for blood management, 44–6

preoperative pulmonary function testing, 189

preoperative pulmonary therapy, 13preoperative respiratory mechanics,

243pressure algometry, 332prevertebral fascia, 159principle of mass conservation, 30progressive seronegative

spondyloarthropathy, 66progressive vertebral body collapse, 68prone position, pathophysiology of,

25, 173, 182and fiberoptic intubation, 57and supraglottic devices, 58and vena cava pressures, 25during posterior cervical spine

surgery, 119–20effect on respiratory system, 25for lumbar laminectomy, 25

prone positioning systems, 218prophylactic antacid therapy, 9propofol, 56, 107, 109–10, 125, 169,

198, 251, 253, 326effect on MEPs, 127impact on evoked potential signals,

109respiratory depressant properties

of, 109proprioceptive sensory pathway, 89ProSeal laryngeal mask airway

(PLMA), 58prostaglandins (PGs), 303–4, 307,

310, 420, 428prostate cancer, 142, 248prostatic screening, 2protein and nonprotein colloids, 29

protein kinase A (PKA), 307protein kinase C (PKC), 307proteus syndrome, 7protons, 324pseudoarthrosis, 141, 311pseudotumor cerebrii, 153pulmonary arterial hypertension

(PAH), 15diagnosis of, 15

pulmonary artery occlusion pressure (PAOP), 15, 33, 35

pulmonary artery wedge catheter, 205

pulmonary edema, 285pulmonary examination, 1pulmonary function

in osteoporotic patient, 9pediatrics, 350–1

pulmonary hypertension, 15–16, 253, 351

pulmonary thermal volume (PTV), 34

pulmonary vascular resistance (PVR), 15

pulmonary venous hypertension, 15pulse oxymetry, 383pulse pressure variation (PPV), role

in functional hemodynamic monitoring, 34

purinergic receptors, 304pyogenic diskitis, 66pyogenic leptomeningitis, 68pyogenic spinal cord abcess, 69pyrimidine nucleotides, 305

quadriparesis, 74quadriplegia, 173QUALEFFO questionaire, 149

radiation myelopathy, 71radiation therapy, 8, 144, 164radicular artery, 231radiculomedullary arteries, 188radiculopathy, 119–20, 216radionuclide bone scans, 66receptor tyrosine kinases

(RTK), 324recombinant activated factor VII

(FVII), in bleeding control during surgery, 46

recombinant activated factor VIIa (FVIIa), 221, 383

recurrent laryngeal nerve (RLN), 6, 115–16, 159, 174, 413

palsy, 185and risk of cervical disectomy, 6

Reeves, Christopher, 17regional anesthesia and analgesia, 327

advantages, 328benefits, 326© in this web service Cambridge University Press

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and choice of surgical technique, 330

epidural, 329infections associated with, 326–7intervention failure, 328medication-related complication,

328neural injuries, 327perineural catheters, 330risks of, 326–8spinal anesthesia, 328–9wound infiltration, 329–30

re-intubations, 14remifental, 110remifentanil, 56, 107–10, 127, 191,

195, 198, 251–2, 309, 326EHL and CSHT, 109

respiratory tract infections, 3retina artery occlusion, 222retraction of trachea, impact, 116retrolisthesis of vertebral body, 182retropharygeal hematomas, 6Rett syndrome, 368, 418Revised Cardiac Risk Index, 12rhabdomyolysis, 276rheumatoid arthritis (RA), 66, 120,

180–1, 210rhizomelic dwarfism, 368rhomboid muscle, 163rib abnormalities, 180right ventricular (RV) outlet tract

obstruction, 223riluzole, 244rocuronium, 127rofecoxib, 311Roland–Morris Disability

Questionnaire (RDQ), 150ropivacaine, 313rotational injuries, 233ROTEM® (Rotem Inc.), 48RV ejection fraction (RVEF), 33

sacral dysplasia, 349sacral hiatus, 130sacral insufficiency fractures, 77sacroiliac joints, 66sagittal FSE/TSE T2 (fast spin echo/

turbo spin echo) with fat saturation, 77

sagittal SE T1, 77sagittal T2*GRE (gradient echo), 77saline, 29–30, 379

vs albumin, 31effects of excessive administration,

30and hyperchloremic metabolic

acidosis, 30and risk of acidosis, 30volume-expanding potential of, 29

sandbag–tape–backboard technique, 239

sarcoidosis, 65–6sarcomas, 248Scheuermann’s disease, 65Schiff Sherrington phenomenon, 199Schmorl’s nodes, 65Schwann cells, 244schwannomas, 84, 248scintigraphy, 13SCIWORA (spinal cord injury

without radiographic abnormality), 354

scleretome, 348sclerotic changes, 64scoliosis, 7, 80–1, 83, 109, 124, 128,

134, 153, 180, 188–9, 194, 253, 313, 350, 354, 358–9, 388

classification, 7MIS for, 133and pulmonary function testing,

189as a secondary symptom, 7and wasting od donated blood, 221

Scoliosis Research Society (SRS), 94scoliosis surgery of pediatrics, 389

anchor fixation, 390females, consideration for, 390midline dissection, 390positioning of patients, 389postoperative monitoring, 394screw placement, 390–3

seat belt injuries, 77second-order axons, 90segmental medullary arteries, 158segmental spinal dysgenesis, 80seizure kindling effect, 96seizures, 201selective serotonin reuptake inhibitors

(SSRIs), 336selegiline, 336sensory neurons, 303sequestrations, 63serotonin, 324serotonin syndrome, 336serotonin/norepinephrine reuptake

inhibitors (SNRIs), 336sertraline, 336severity score, 234sevoflurane, 108–9, 169Sharp and Purser test, 3shear injuries, 234shivering, 336short-acting muscle relaxants, 164Short-Form 36 Health Survey, 149SI joints, 66sick cell disease, 61Siemens positioning system, 218single epidural catheter, 421–2single-lumen ETT, 57sirolimus, 248sleep apnea, 3, 14–15, 153sleep disorders, 142

Smith fracture, 77smoking, relation with diabetes, 13sodium voltage-gated channels, 305soft tissue neurofibromas, 181somatosensory evoked potentials

(SSEPs), 89, 107, 123, 173, 220, 241, 249, 273, 389

amplitude of, 124and anesthetic agents, 93, 169background, 89–90bandpass and sweep sensitivity, 91benefits, 90and body pressure, 93and body temperature, 93, 124and choice of anesthetic agents, 107common peroneal nerve, 90cortical responses, 93cutoffs, 93desflurane/remifentanil anesthesia,

110during anterior cervical surgery,

115during intramedullary tumor

resection, 167effect of nitrous oxide, 127efficacy of, 94Erb’s point potential (EP), 91and etomidate infusion, 109and fentanyl infusion, 109intensity of electrical stimulus, 90intramedullary tumor resection,

165of localization of neural insult, 94LP wave form, 92and mean arterial pressure, 93and median nerve stimulation, 90methodology, 90–1monitoring of neuronal integrity,

124of motor pathways, 94N13 wave form, 91N20 wave form, 92N34 wave form, 92and negative predictive values, 94of neural generators for each wave

forms, 90and neurologic injury, 220and nitrous oxide, 108nomenclature of wave form, 91and opioids, 169outcomes, 94P14 wave form, 91P37 wave form, 92PF wave form, 92placement of electrodes, 90and positive predictive value, 94posterior tibial nerve, 90potential points for recording, 89and proprioceptive sensory

pathway, 89recovery of potentials, 169© in this web service Cambridge University Press

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and reduction of neurologic deficits after surgery, 90

sensitivity of, 124sensitivity and specificity of

unimodal, 94and sensory modlaities, 124significant findings, 91–4of somatosensory pathway, 90subcortical and spinal responses, 94of surgically induced injuries, 168as a surveillance tool, 124and tourniquet, 127technical limitations, 91transcutaneous stimulation, 90of ulnar nerve, 90of upper limbs, 90and use of averaging responses, 91using bar electrodes, 90using EEG electrodes, 90using subdermal needle electrodes,

90warning criteria, 93–4

somitomeres, 348Sonoclot® (Sienco Inc.), 48spastic quadriplegia, 352spasticity, 3, 153spasticity management devices, 341spina bifida (spinal dysraphism), 7,

350spinal anesthesia, for spinal surgery,

57–8and extermity thrombo-embolic

complications, 58in pain control, 58and perioperative complications, 58and perioperative hemodynamic

stability, 58spinal aneurysms, 72spinal angiography, 73spinal canal stenosis, 63–4spinal column, surgical anatomy of,

292–4spinal cord blood flow, 231spinal cord compression, 142spinal cord edema, 77–8spinal cord hemorrhage, 77–8spinal cord injury (SCI), evaluation

of, 77, 199related to ischemia, 169

spinal cord injury syndromes, 234spinal cord ischemia, 108, 159, 189,

295–6spinal cord neoplasms, 114spinal cord recordings, disadvantages

of, 97spinal cord stimulation, of the motor

system, 96spinal cord tumors, 172

adjunctive therapy, 248and anesthetic agents, 250anesthesia and location of tumor,

249anesthetic technique, 250chemotherapeutic agents, 248chemotherapy, 248common types, 247distal effects, 247EEG monitoring, 253effect of intravenous agents, 251emergent surgery, 252etiology, 247–9ideal preoperative preparation, 249intraoperative management,

249–53and maintenance of blood pressure,

252management of TIVA during

surgery, 250and neuroblocking agents, 251neurological deficits, 249and opioids, 249, 252oral narcotics, 249pain due to, 247pediatric, 353postoperative analgesia, 253–4postoperative management, 253–4postoperative morphine

requirements, 249preoperative care, 248–9presentation, 247radiation therapy, 248and remifentanil, 252surgical plan, 252treatment options, 248use of EP recordings, 249

spinal cord, cross-section of, 229spinal degenerative disease, 184spinal distraction, 106spinal injury classification systems,

234spinal instability, 234spinal kinking, 106spinal metastasis

primary sources, 8removal of, 8

spinal movement, of cervical spine, 240

spinal muscular atrophy (SMA), 7, 351–3, 362, 368

spinal nerve, 179spinal percussion, 143spinal reconstruction, 115spinal sarcoidosis, 65–6spinal shock, 18, 199–200, 295spinal stability assessment model, 75spinal stenosis, 9, 71, 106, 172

with neurologic compromise, 66spine fractures, 229spine imaging

acute transverse myelopathy, 70–1AIDS-related myelopathy, 71aneurysms, 71

ankylosing spondyilitis, 66arteriovenous malformations, 72–3Baastrup disease, 64cavernous angiomas, 73cervical spine injuries, 75chronic cord infarct, 74closed spinal dysraphisms (CSD)

with a mass, 80closed spinal dysraphisms (CSD)

without a mass, 80closed spinal dysraphisms (CSD)

without a mass, complex, 80compression of spinal cord, 64compressive myelopathy, 71congenital anomalies of spine and

spinal cord, 79cord infarction, 73–5degenerative and toxic

myelopathies, 71degenerative diseases, 63–5degenerative facet disease, 64demyelinating diseases, 69–71disc disease, 63–4DISH, 64–5epidural abscess, 68evaluation of marrow signal

abnormalities, 61granulomatous spondylitis, 67–8of infections, 66–9intradural extramedullary

neoplasms, 84–5intramedullary abscess, 69intramedullary neoplasms, 81intrathecal drop metastases, 85main sequences, 61meningitis, 68–9neoplastic disease of the spine, 81normal spine, 61–3open spine dysraphisms (OSD), 79OPLL, 64osteomyelitis, 66paraspinous abscess, 69pyogenic diskitis, 66radiation myelopathy, 71rheumatoid arthritis, 66sarcoidosis, 65–6Scheuermann’s disease, 65Schmorl’s nodes, 65scoliosis, 80–1spinal stability assessment, 75spine trauma, 75–9subdural abscess, 68superficial siderosis, 71thoracolumbar spine injuries, 77vascular diseases, 71–5vascular malformations, 72

spine immobilization, management of, 239–40

spinocerebellar degenerations, 71spinoreticulothalamic tract, 303spinothalamic tract, 303© in this web service Cambridge University Press

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spinous processes, 61, 64, 119, 144, 154, 162–3, 173, 178, 188, 233, 330, 351, 390, 394

split cord malformation, 399spondylectomy, 217spondyloarthropathy, 71spondyloepiphyseal dysplasia, 181spondylolisthesis, 9, 64, 134, 138, 175,

350of the vertebral body, 77

spondylolysis, 77, 350spondylosis, 113–14, 162spondylotic myelopathy, 120spontaneous electromyography

(sEMG), 220spontaneous EMG activity, 126spontaneous muscle activity, 126Sprengel deformity, 180stage III prostate cancer, 142stage IV breast and lung cancer, 142Stagnara test, 362Stagnara wake-up test, 95Staphylococcus aureus, 66, 68, 326Staphylococcus epidermidis, 326Starling principle, 26sternocleidomastoid muscle, 114–15sternohyoid muscle, 159sternotomy, 159steroid use, in traumatic spinal cord

injury, 172STIR (short tau inversion recovery),

77STOP questionnaire, 15Storz video laryngoscope, 53stress myocardial perfusion imaging,

13stroke, 190strong ion difference (SID), concept

of, 30Study of Osteoporosis Fracture–

Activities of Daily Living (SOF-ADL), 150

stylet intubation, 54subacute necrotic myelitis, 75Subaxial Cervical Injury Classification

and Severity Scale (SLIC), 235subaxial cervical injury classification

system, 234subaxial cervical spine, 120, 229subaxial spondylotic myelopathy, 120subclavian artery, 180subdural abscess, 68subligamentous spread, imaging of, 68suboccipital craniectomy, 152substance P, 303, 305, 324succinlycholine-induced

hyperkalemia, 55succinylcholine, 54, 127, 242, 353succinylcholine usage, during spine

surgery, 54

suctioning technique, 47sufentanil, 109, 127, 195, 309

EHL and CSHT, 109sugar-nucleotides, 305sunitinib, 248superficial siderosis, 71superior facet, of cervical vertebrae,

178superior mesenteric artery (SMA)

syndrome, 276–7superior vena cava (SVC), 409supraclavicular incision, 159suprafascial implant, 131supraglottic airway devices, 52, 57–8,

198supraspinal sensory centers, 303supraspinous ligament, 75supreme laryngeal mask airway, 58surgical consent, 1surgical invasiveness, degree of, 1Swan–Ganz catheter, 242sympathectomy, 194sympathetic hyperactivity symptoms,

201sympathetic preganglionic neurons,

200symptomatic lumbar disc herniations,

130synapses, of proprioceptive sensory

pathway, 89–90syncope, 153syndecan-1, 27synkinesis, 180synovial cyst, 64synthetic cages, 116syringomyelia, 4–5, 7, 152

complications with, 4diagnosis of, 5signs and symptoms, 4surgical procedures, 4

syrinx draining procedure, 5systemic cooling, 296systemic lupus erythematosus (SLE),

71systolic pressure above baseline, 35systolic pressure variation (SPV),

role in functional hemodynamic monitoring, 34–5

T1 marrow images, 61T1-weighted imaging sequences, 61

cavernous angiomas, 73cord enlargement, 74extradural soft tissue mass, 68focal cord enlargement, 71leptomeningeal enhancements, 65sarcoidosis, 65soft tissue changes, 78type I endplate changes, 63type II endplate changes, 64

type III endplate changes, 64VCF, 143

T2-weighted imaging sequences, 61associated cord swelling, 71cavernous angiomas, 73extradural soft tissue mass, 68facet effusions, 64focal or generalized cord atrophy,

70hyperintense intramedullary lesion,

70myelitis, 69poorly delineated hypertensities, 71sarcoidosis, 65soft tissue changes, 78type I endplate changes, 64type II endplate changes, 64type III endplate changes, 64VCFs, 143

tachycardia, 322traumatic spinal injury (SCI)

surgical plan, 239TcMEP CMAP responses, 97teardrop fracture-dislocation, 233terminal myelocystoceles, 80tethered cord, 80, 123tethered spinal cord

asymptomatic, 398diagnosis of tethered cord, 398equipment, 403postoperative considerations, 403preoperative measures, 400–1surgical approach, 401types of tethered cords, 399–400

tethered spinal cord, surgery for, 398clinical setting, 398–9

tetralogy of Fallot (TOF) anesthetic considerations, 408management, 408overview, 407

tetratrodotoxin-resistant Nav1.8 gene, 306

thermal hyperalgesia, 304thickened filum terminale, 80, 398–9,

401–2thiopental, 108

benefits of, 108third cervical (C3) vertebra, 54third-order axons, 90third-order neurons, 90thoracic and lumbar spine fracture, 77thoracic aortic aneurysm surgery, 244thoracic cage deformity, 351thoracic duct injury, 159thoracic epidural–general analgesia, 7thoracic pedicle screws, monitoring

of, 103–4thoracic spinal cord trauma, 191thoracic spine

anatomy, 188© in this web service Cambridge University Press

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anterior approaches to surgery, 159–61

body of thoracic vertebrae, 188C5–T3 vertebrae, approach to, 159dorsal branch, 158drawbacks related to surgical

access, 188exposure of T2–T1 vertebral levels,

159and ischemic complications, 159level of injury in, 188manubrium opening, 159posterior approaches to surgery,

161–3segmental medullary arteries, 158spinuous processes, 188trauma, 191vasculature of, 158–9, 188watershed zone, 159

thoracic surgery and anticoagulation, 199autonomic dysreflexia, 200–1and blunting of sympathetic

reflexes, 200emergency and urgent procedures,

198–201epidural abscess, 199and epidural hematoma, 199neuro-intensive care for, 299–300open, 189–93posterior approach to surgery, 188removal of tumors, 8scoliosis, 7–9and spinal shock, 199–200thoracic sympathetic ablation for

hyperhidrosis, 189thoracoplasty, 7–9vascular catastrophes, 199

thoracic vertebral column, 188, 197thoracic vertebral corpectomy, 189thoracolumbar area, 73thoracolumbar fractures, 77Thoracolumbar Injury Classification

and Severity Score (TLICS), 234–5

thoracolumbar junction, 161, 175thoracolumbar spine, imaging of, 231thoracolumbar spine injuries, 77thoracolumbar spine surgery, 307thoracoplasty, 7thoracoscopic sympathectomy, 196thoracoscopy, 134

anesthesia management, 195and arterial blood gas evaluation,

194assessment of asymptomatic

conditions, 194and cardiac complications, 196complications, 196hemodynamic changes during, 194

and hemorrhage, 196and hypotension, 196in patients with connective tissue

disorder, 194indications for, 193and inotropic infusion, 194intraoperative considerations,

194–5and lymphatic injury, 196and nerve injury, 196patient positioning, 194postoperative considerations, 195–6preoperative EKG, 194preoperative evaluation, 194risk for bilateral pneumothorax,

194technical difficulties, 195and vessel injury, 196video-assisted, 193

thoracotomy, 159, 175, 190diaphragm opening, 161disadvantages, 161manipulation of aorta, 160patient position for, 159rib exposure, 160risk for pain syndrome, 161

three-dimensional CT reformats, 75thrombocytopenia, 48, 197, 248thrombocytosis, 17Thromboelastogram TEG®

(Haemoscope Corp.), 48thromboembolism, 219, 224thromboxanes, 324thyroid cartilage, 180thyrotropin-releasing hormone, 243tinnitus, 153tissue ischemia, 238titanium pedicle screws, 141titanium plates, 116, 140

insertion procedure, 5TNF receptor (TNFR) 1, 304TNF receptor (TNFR) 2, 304tongue swelling, 56, 174total intravenous anesthesia (TIVA),

127, 220tourniquet, 127toxic myelopathies, 71tracheal intubation management,

during spine surgery, 50concerns, 50in patients with cervical spine

instability, 54precautions, 52wire-reinforced endotracheal tubes,

52tracheal retraction, 116tracheobronchial trauma, 212tracheoesophageal structures, 159tracheostomy, 3, 116tramadol, 333, 341, 343, 429

tranexamic acid (TXA), 46, 221transcranial motor evoked potentials

(TcMEPs), 96, 109, 220transcranial stimulation, of the motor

cortex, 95transdermal systems, 248transesophageal echocardiography

(TEE), 21, 33study of prone position, 25

transforaminal lumbar interbody fusion (TLIF), 131–2

transfusion-associated acute lung injury (TRALI), 43

transient neurologic symptoms (TNS), 328

transient paraplegia, 168transient receptor potential (TRP) ion

channels, 324transient receptor potential (TRP)

receptors, 303–4transient receptor potential vanilloid

receptors, 304transient receptor potential vanilloid

subfamily 1 (TRPV1) receptor, 304

transient sore throat, 117translation injuries, 234transpedicular approach, to VCF

management, 144trans-sacral lumbar interbody fusion,

134transthoracic endoscopic

sympathectomy, 196transverse atlantal ligamentous injury,

75transversus abdominis plane (TAP), 6tranylcypromine, 336trapezius muscle, 163trauma fractures of vertebral bodies,

159traumatic cord injuries, 121traumatic disk extrusions, 78traumatic glottic edema, 212traumatic spinal cord injury (SCI)

anatomy, 229–31anesthetic management, 238–41average age at onset, 229axial compression injuries, 232and cell transplantation, 244CT imaging, 231distraction injuries, 234economic cost of, 229electrophysiologic monitoring, 241epidemiology, 229etiology, 229extubation technique, 243flexion injuries, 233and functional impairment, 229hemodynamic management,

241–2© in this web service Cambridge University Press

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hypertension injuries, 233and hypotension, 242MRI studies, 231and muscle relaxants, 242and neurogenic shock, 242neurologic assessment and

classification, 234neuroprotection and repair, 243pathophysiology of, 234–8pediatrics, 353–4physical exam, 231physiology, 229–31primary injury, 235racial differences, 229radiologic evaluation, 231and respiratory impairment and

pulmonary complications, 242and respiratory mechanics,

242–3rotational injuries, 233secondary injury, 235spinal instability, 234systemic effects of, 239translation injuries, 234

traumatic spondylolisthesis, 75tremor, 153Trendelenburg position, 223tretradotoxin-resistant sodium

channels, 306tricuspid insufficiency, 15tricyclic antidepressants (TCAs), 336

adverse effects, 336trigeminal neuralgia, 153triggered electromyography (tEMG),

220triggered EMG monitoring, 89, 126

aim, 102background, 102commonly used electrodes in, 102cost-effectiveness, 104effect of malpositioned

screws, 102and false-negative results, 103low-threshold stimulation

intensities, 103methodology, 102outcomes, 103–4and paralytics, 103placement of thoracic screws, 103positive predictive values, 104of potential impingement on a

nerve root, 103significant findings, 102–3simulation thresholds, 102spinal instrumentation in, 102standard gains and sweep speed,

102stimulation parameter and

technique, 102

thoracic pedicle screws, 103–4triptans, 342trisomy 21, 3

perianesthetic conditions, 3TROX-1, 307TRPV1 knockouts, 304TRPV1 receptor antagonists, 304tuberculous spondylitis, 67–8tubular retractor

development of, 131in microdiscectomy, 131

tumor debulking, 217tumor necrosis factor (TNF), 304tumor necrosis factor-α (TNF-α), 324two-pore potassium channels (K2P),

324type I (“Chance” fracture), 77type I nociceptors, 303type II nociceptors, 303

unilateral mandibular hypoplasia, 355Univent® Tube, 206unstable cervical injuries, 240unstable thoracolumbar injuries, 229upper airway management, during

spine surgery airway edema in spine cases, 56fiberoptic intubation and awake

intubation, 55–6Intubation Difficulty Scale (IDS),

52laryngoscopes, 52–3management of accidental

extubation, 57in patients with cervical spine

instability, 54role of ASA algorithm for

management of difficult airway, 52

spinal anesthesia, 57–8tracheal intubation, 50–2, 54and use of double-lumen tube

(DLT), 57use of succinylcholine, 54using supraglottic airway devices,

58–9upper cervical injuries, 229upper cervical spine, 229urgent intubation, 240uvulopalatopharyngoplasty, 14

VA National Surgical Quality Improvement Program database, 17

VACTER syndrome, 368Valsalva maneuver, 8, 153valvular disease, 10valvular lesions, 411vancomycin, 154VAS Functional Scale, 149vascular anastomosis, 285

vascular compromise, 106vascular injury, during lumbar

surgery, 223vascular occlusion, 71vascular risk factor, 259–61, 263vasoconstriction, 201vasopressors, 121, 222–3, 296VATER association, 349venlafaxine, 342venography, 144venous air embolism (VAE), 173–4,

223–4venous hypertension, 73venous infarction, 75venous pooling, 173ventral posterolateral (VPL) nucleus,

90ventricular defects, 3ventricular septal defects

anesthetic considerations, 407management, 407overview, 407

verbal pain scale (VPS), 342vertebral artery injury, 75vertebral artery thrombosis, 79, 183vertebral body

infection, 66tumors, 159

vertebral compression fractures common fractures, 142consequences of, 142indicators of, 143mortality due to, 142physical consequences, 142psychological consequences, 142and pulmonary

dysfunctions, 142vertebral compression fractures, MIS

for adjacent fractures, risk of, 147–8AP projection, 144cement extravastation, 144cement leakage, risk of, 147central cavity creation, 146clinical benefits, 148complications, 146–7extrapedicular approach, 144IBT placement, 144–5kyphoplasty, 144–5medical management of, 144modalities for, 143MRI imaging, 143orthopedic principles of, 144outcome and efficacy, 147–50pain relief measures, 147patient selection, 143pulmonary reactions, 147trajectory before needle

positioning, 144transpedicular approach, 144trocar placement, 144

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vertebroplasty, 144vertebral fractures, 9, 109vertebral hemangiomas, 248vertebral metastases, 248vertebral pedicle, 126vertebral scalloping, 84vertebrectomy, 217vertebroplasty, 8–9, 17, 188

administration of PMMA, 8anesthesia management, 198benefits of, 149and cardiac condition, 197and cement leak, 198, 224cement pulmonary embolism, 224complications, 147, 198contraindications, 196intraoperative considerations,

197–8opioid boluses for, 198patient positioning, 198postoperative considerations, 198

preanesthetic assessment, 9preoperative evaluation, 197and pulmonary system, 197steroid use, 198using PMMA, 148for VCF, 144

video laryngoscopes, 240video-assisted thoracoscopy (VATS),

193, 213location for surgery, 194lung ventillation, 194physiologic changes during, 194pulmonary involvement, 194

visual blackouts, 153visual field cuts, 153visual loss after spine surgery, 173vitamin B12 deficiency, 71vitamin D, 144vitamin K-dependent clotting factors,

366vocal cord paralysis, 116–17, 153

volatile agents, 107voltage-activated calcium channels,

306voltage-gated ion channels, 305volvulen, 379

wake-up test, 106–7, 109, 173, 190, 220, 362

Wallenberg syndrome, 183wedge vertebra, 80“well localized fast” pain, 303white coat syndrome, 11white matter tracts, 231wide dynamic response, 303Wilson frame, 191, 218–19,

260, 265–6wire-reinforced endotracheal tubes,

52wound hematoma, 117, 185

zolpidem, 342© in this web service Cambridge University Press

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