P034: AWAKE AMBULATORY SPINE SURGERY FOR LUMBAR SPINAL STENOSIS: A CASE REPORT
Helena Krogman; Shahrukh Bengali, MD; Sanjeev Kumar, MD
University of Florida
Spine surgery has traditionally been performed under general endotracheal anesthesia (GETA) which carries recognized perioperative risks including hemodynamic instability, pulmonary complications, and postoperative cognitive dysfunction. Advances in minimally invasive endoscopic spine surgery have expanded the feasibility of surgical intervention in patients previously considered higher risk with traditional approaches. Endoscopic spine procedures performed under epidural anesthesia with conscious sedation may be a feasible alternative and provide effective surgical analgesia while preserving spontaneous ventilation and patient responsiveness.
We present a 77-year-old male with symptomatic lumbar spinal stenosis who underwent L3–4 interlaminar endoscopic decompression with unilateral laminotomy for bilateral decompression under epidural anesthesia in an ambulatory setting. His medical history included infrarenal abdominal aortic aneurysm (5.1 × 4.9 cm), complex ventral abdominal wall hernia, chronic obstructive pulmonary disease, coronary artery disease, benign prostatic hyperplasia, and prior prostatic adenocarcinoma.
The anesthetic regimen consisted of epidural administration of bupivacaine 0.125% with a low-dose dexmedetomidine infusion for light sedation. The patient remained awake and responsive throughout the procedure which allowed for continuous neurologic assessment. He remained hemodynamically stable intraoperatively and experienced an uncomplicated recovery with effective analgesia and early ambulation.
Epidural anesthesia with conscious sedation may offer meaningful advantages over GETA for an aging population with increasing medical comorbidities. This case demonstrates that epidural anesthesia with conscious sedation may be a feasible option for endoscopic spine procedures although further safety and feasibility studies are warranted.