Anesthesia for the outpatient ambulatory surgery center has to be tailored to
the surgery. The length of surgery, the trauma of painful dissection, and the amount of
blood loss have to be considered. Outpatient spine surgery is characterized by shorter
simplified versions of their inpatient counterparts carried out in a hospital setting.
Many outpatient spine surgeries are minimally invasive through small incisions with
less blood loss, tissue disruption, and, more importantly, less painful stimulus during
surgery. These modern spine surgery versions also apply local anesthesia strategically
to diminish the need for deep anesthesia. In some scenarios, the surgeon may wish to
speak to the sedated yet awake patient to lower the risk of injury to neural structures
when performing the more dangerous portions of the endoscopic decompression
surgery. The need to communicate with the patient is undoubtedly of high relevance in
the cervical spine, which requires the anesthesiologist to tailor the management of the
patient’s anesthesia to the surgeons’ needs. The monitored anesthesia care (MAC),
where sedation is achieved with various sedatives and narcotics, is most appropriate for
outpatient endoscopic cervical spinal surgeries. These surgeries may be performed with
the patient in supine (anterior cervical surgery) or in a prone position (posterior cervical
surgery). Patients in the prone position may pose additional problems maintaining
adequate ventilation and sedation while keeping the patient comfortable enough to
tolerate the procedure and yet still communicating with the surgeon. In other scenarios
or different surgeon preferences communicating with the patient during an outpatient
endoscopic cervical surgery may not be required. A Laryngeal Mask Airway (LMA)
may be more appropriate with the patient in a prone position. This chapter describes modern MAC concepts, airway management in the supine and prone position, and
sedatives as it applies to cervical endoscopic spinal surgery in an ambulatory surgery
center.
Keywords: Balanced Anesthesia, Cervical Spine Endoscopy, Monitored
Anesthesia Care.
