Abstract SNACC-18

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Biochemical abnormalites following prone position for spinal surgery

Taylor J, Nagaratnam V, Hoogenboom E, Sengupta S, Luoma A
National Hospital for Neurology and Neurosurgery, London, , United kingdom

Prone position for surgery is associated with complications [1] including severe such as visceral hypoperfusion and rhabdomyolysis [2,3]. Factors associated with complications following prone surgery include obesity, blood loss and duration of anaesthesia [4,5]. At our institution prone position is commonly used for both spinal and intracranial surgery. Our normal technique is to use a Montreal Mattress with a ‘Prone View’ or Mayfield Clamp as indicated.

To quantify the incidence of complications following prone positioning after complex spinal surgery at our institution and identify associated factors.

• Prospective audit for two 6month periods between April 2012 – April 2014
• Data collected included patient demographics, surgical details, medical history and complications
• Complications due to prone position were collected intra-operatively, immediately and 24 hours post-operatively
• Patients with nerve complications were followed-up until resolution

160 patients were included. The incidence of immediate and late complications was high [58.5% and 46.3%] but the majority resolved rapidly (See tables 1 and 2).

Although not clinically significant, an unexpectedly large number of our patients had abnormal biochemistry suggestive of organ hypoperfusion post-operatively, in particular elevated liver enzymes and amylase. Creatine kinase [CK] was elevated in a large number of patients and we had no incidences of clinical rhabdomyolysis. CK may be elevated due to the surgical procedure but there is little data to quantify a normal level following spinal surgery. It is important to check liver and renal function post-operatively in patients under going prolonged procedures in the prone position.
Complications were unrelated to age, gender or BMI and also to surgical factors such as number of vertebral levels operated on, blood loss and duration of surgery.

1. Edgecombe et al BJA 100 (2): 165-183 (2008)
2. Ziser et al Anesthesia and Analgesia 82 (2): 412-415 (1996)
3. Papdakis et al Journal of Neurosurgery 9 (4): 387-398 (2008)
4. Lee et al Anesthesiology 2006; 105:652–9
5. The Postoperative Visual Loss Study Group Anesthesiology 116 (1): 15 – 24 (2012)

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