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Take note of any chronic pain medications currently in use to determine appropriate perioperative analgesic regime.

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Sep 26, 2012
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Cease any long acting antiplatelet therapy (clopidogrel) 7-10 days before surgery where possible to minimise perioperative blood loss.

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Sep 07, 2011
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Withhold aspirin on day of surgery

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May 18, 2011
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Patients undergoing cervical or thoracic laminectomy/fusion will have their arms by their side under the drapes. Intravenous access will need to be obtained and secured prior to placing in prone position. Consider inserting a central line at induction while the opportunity is still present.

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Sep 08, 2011
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If a laminectomy without fusion is being performed, place 2 large bore IVCs. If multilevel fusion (at risk of significant blood loss) consider a central line (CVC) as this will be difficult to insert in the prone position, or at least 3 large bore IVCs (third as a backup in case one fails)

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Oct 14, 2011
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Intravenous cannulae should either be in upper arm or forearm in those patients who will have their arms outstretched and flexed 90 degrees at the elbows.

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Oct 14, 2011
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Ask surgeon if they want to perform functional testing when operating near the spinal nerve roots (~60mins into procedure) to look for evidence of lower limb contraction. Patient will need to have muscle relaxation fully reversed at this stage.

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Nov 05, 2011
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Intraoperative methadone (~0.2mg/kg) improves postoperative pain scores and reduces opiod requirements in spinal surgery.

journals.lww.com/anesthes...,.5.aspx

www.anesthesia-analgesia....

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Jul 24, 2014
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If unable to adequately manage haemorrhage or administer adequate volume resuscitation, consider packing wound, transferring to ICU, and returning to theater when the patient is optimised.

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Oct 14, 2011
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If using cell saver (eg multilevel fusions), the flow is limited by the filter and cannot be relied upon as sole volume resuscitation source. In a life threatening emergency requiring rapid volume replacement, the filter may be removed from the line.

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Sep 07, 2011
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