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Canadian Journal of Anesthesia, Vol 32, 248-257, Copyright © 1985 by Canadian Anesthesiologists' Society

Clinical Reports: Anaesthetic Management of Posterior Lumbar Osteotomy

DAVID G. WILLS MD FRCP(C)1

1 Department of Anaesthesia, the Toronto East General and Orthopaedic Hospital and the University of Toronto, Toronto, Ontario

Address correspondence to: Dr. David G. Wills, Department of Anaesthesia, Toronto East General and Orthopaedic Hospital, 825 Coxwell Avenue, Toronto, Ontario, M4C 3E7. After August 1985: Department of Anaesthesia, The Halifax Infirmary, 1335 Queen Street, Halifax, Nova Scotia, B3J 2H6.

Sixty-four cases of posterior lumbar extension osteotomy performed at the Toronto East General Hospital between 1969 and 1983 are reviewed. The anaesthetic management is presented. The procedure was performed with local infiltration anaesthesia, heavy sedation and a brief period of general anaesthesia induced with nitrous oxide, halothane or ketamine. Five stages in the anaesthetic management are distinguished, each in relation to a phase of the surgical procedure and drug usage. A method of supporting these deformed patients in the prone position in moulded plaster casts is described. Anaesthetic and surgical complications and postoperative psychological disturbances are described and discussed. It is suggested that caudal epidural opioid or local anaesthetic analgesia be explored as an aid in the management of these patients.

Key Words: SURGERY: lumbar osteotomy • ANAESTHETIC TECHNIQUES: intravenous sedation, general, caudal epidural • ANAESTHETICS, INTRAVENOUS: ketamine • ARTHROPATHIES: ankylosing spondylitis






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Copyright © 1985 by the Canadian Anesthesiologists' Society.