During week two,  the trainee will expand their knowledge to include management of complex spine surgery and awake craniotomy. They will:

• Identify the perioperative concerns in complex spine surgery and management strategies for preventing and managing blood loss
• Compare the use of total intravenous anesthesia (TIVA) with other anesthetic techniques when intraoperative monitoring is used
• Discuss the advantages of multimodal analgesia for spine surgery
• List the anesthetic considerations and potential complications for awake craniotomy

Complex spine surgery

• • • Articles:
      • Management of complex spine surgery. (PMID: 28731875)
      • Extubation after Multi-level Spine Surgery (PMID: 24296539)
      • Diagnosis and Treatment of Neuroanesthetic Emergencies (PMID: 30334936)
      • ERAS for Spine Surgery (PMID: 28009223)
      • SNACC Clinical Practice Guidelines for perioperative care of patients for complex spine surgery (PMID: 34483301)
  • • Clinical Audio and Video Corner
      • Anesthetic Management for Complex Spine Surgery, May 2018
    • Quiz
      • Considerations with positioning for neurosurgical procedures.

Considerations and concerns in cervical spine surgery

• • • Articles
      • Injury and Liability associated with spine surgery (PMID: 28763433)
      • Cervical spine movement in a cadaveric model of severe instability: comparison of 4 different laryngoscopes, (PMID: 28230622)
      • Intubating LMA-assisted flexible bronchoscopy intubation and cervical spine motion (PMID: 30893284)
      • Dysphagia after Cervical spine surgery (PMID: 30794969)
    • Interactive case
      • Cervical Spine and Airway Issues

Managing pain in spine surgery patients

• • • Quiz
      • Perioperative management in patients with Chronic pain
    • JNA Podcast
      • Opioid Alternatives in Spine Surgery (January 2022, Dr. Shilpa Rao)    
      • Article of the Month: Opioid Alternatives in Spine Surgery (PMID: 32568816)
  • • Articles
      • Incidence and Risk factors for chronic postoperative opioid use after major spine surgery, (PMID:29570151)
      • Best Evidence in multimodal pain management in spine surgery (PMID: 25766366)
      • Multimodal analgesic regimen for spine surgery: a randomized placebo-controlled trial (PMID: 32235144)
      • Pain management after complex spine surgery: a systematic review and procedure-specific postoperative pain management recommendations (PMID: 34397527)
      • Intraoperative and postoperative administration of Dexmedetomidine reduces anesthetic and postoperative analgesic requirements in patients undergoing cervical spine surgeries (PMID: 27035842)

Methadone, ketamine, and dexmedetomidine for spine surgery

• • • Quiz
      • Ketamine in Neuroanesthesia
    • Fellows’ and Residents’ Audio Corner
      • Multimodal analgesia for Spine Surgery (April 2022, Dr. Shobana Rajan)
    • Articles
      • Safety profile of intraoperative methadone for analgesia after major spine surgery (PMID: 29733094)
      • Perioperative methadone and ketamine for postoperative pain control in spinal surgical patients: a randomized double-blind, placebo-controlled trial (PMID: 33730151)
      • Perioperative Ketamine for analgesia for spine surgery: a Meta Analysis (PMID: 28700455)
      • Comparison of small dose Ketamine and Dexmedetomidine infusion for postoperative analgesia in spine surgery. (PMID: 26018671)

Lidocaine for pain management in spine surgery

• • • Articles
      • Systematic Review and Meta-Analysis: Perioperative IV Lidocaine on complex spine surgery PMID: 33235097
        • SNACC Commentary on Article of the month, June 2015
      • Farag E., et al. Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and the quality of life after complex spine surgery (PMID: 23681143)

Regional anesthesia for spine surgery

• • • Articles
      • Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery, a case series (PMID: 29704223)
      • Erector spinae plane block for spine surgery, a systemic review (PMID: 33983515)

Intraoperative electrophysiological monitoring and anesthesia for complex spine surgery

• • • Interactive Neuromonitoring Clinical Cases
      • Neuromonitoring for spinal deformity surgery
      • Why can’t we get good baseline motor evoked potentials in this patient?
      • What should I plan for maintenance anesthetic if neuromonitoring is involved in this case?
    • Article
      • Introduction to intraoperative neurophysiological monitoring for anaesthetists (WFSA)

Tranexamic acid for spine surgery

• • • Articles
      • Intraoperative tranexamic acid use in major spine surgery in adults (PMID: 28203735)
        • SNACC Commentary

Spine surgery for AVM/AVF resection and tumors

• • • Articles
      • Anesthesia considerations and intraoperative monitoring during surgery for arteriovenous malformations and dural arteriovenous fistulas (PMID: 22107866)
      • Contemporary management of Spinal AVF’s and AVM’s, (PMID: 25175433)

Supplementary reading (SNACC Bibliography collection)

• • • Multimodal Analgesia in Spine Surgery ( Pain Management → Multimodal Analgesia for Spine Surgery)

Anesthesia for awake craniotomy

• • • Fellows’ and Residents’ Audio Corner
      • Anesthesia for awake craniotomy, (April 2017, Dr. Sergio Bergese)
        • Articles:
          • Awake Craniotomy: anesthetic considerations based on outcome evidence, (PMID: 31107256)
          • Comparison of the Asleep- Awake-Asleep technique and monitored anesthesia care during awake craniotomy, (PMID: 31972627)
          • Awake vs Asleep motor mapping for glioma resection, (PMID: 32388682)
          • Cognitive and linguistic outcomes after awake craniotomy, (PMID: 32738586)
          • Feasibility of Awake craniotomy in the pediatric population, (PMID: 32856774)
          • Dexmedetomidine as adjunct in awake craniotomy, (PMID: 32090308)

Challenges during awake craniotomy

• • • Articles
      • Awake craniotomy in a patient with previously diagnosed PTSD, (PMID: 32278819)
      • Awake craniotomy: improving the patient’s experience, (PMID: 26263121)
      • Intraoperative Seizures during Awake Craniotomy, (PMID: 23615101)
      • Awake Craniotomy in low resource settings. (PMID: 33091650)
      • Awake craniotomy under 3-Tesla intraoperative MRI imaging, (PMID: 32482989)

Challenging cases: SNACC Newsletter

• • (Spring Newsletter 2019): Awake craniotomy in a patient with history of Malignant Hyperthermia.
  • (Winter Newsletter 2018): Awake craniotomy in the intraoperative MRI suite.
  • (Fall Newsletter 2018): Awake craniotomy for an aterio-venous malformation in the eloquent area.

   SNACC Bibliography collection :

• Awake Craniotomy (Neurosurgery → Awake Craniotomy)
• Managing Craniotomy pain (Pain Management → Post-Craniotomy Pain Syndromes)