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Anesthesic Considerations for Spine Patients

- Pre-anesthetic Considerations:
    - in spine injured patients, anesthesia is necessary even if the extremity is insensate inorder to prevent spasm and automatic dysreflexia;
          - need to monitor for automatic dysreflexia (spinal anesthesia preferred);
    - be aware that acture high paraplegics, because of generalized venous dilation, may require larger than usual volumes of fluids to maintain 
          adequate blood pressure;
          - consider Swan Ganz monitoring;
    - be aware that chronic SCI pts have low intravascular volumes and are usually sensitive to further losses of volume;
    - wrap the lower extremity to prevent blood loss;
    - protect pts in the prone position with bilateral rolls from increased

- Technical Pearls:
    - carry out awake, fiberoptic intubation w/o moving neck;
    - No Sellick Maneuver !
    - although use of succinylcholine is contraindicated several days after denervation injury, there is no evidence of muscle membrane instability 
         in the first few hours;

- Post Op Considerations:
    - 5% of myelopathic patients who undergo anterior C-spine surgery will require re-intubation;
          - risk is increased by surgery on multiple levels;
          - risk is decreased by fibro-optic intubation and by keeping the head of the bed elevated to 30-40 deg postoperative (to reduce edema)