The specialty of pain management includes the utilization of many spinal interventional procedures including intralaminar and transforaminal epidural injections, facet joint and medical branch nerve blocks, radiofrequency neruolysis of nerves, sympathetic nerve blocks, implantation of spinal cord stimulators and intrathecal pumps, as well as intradiscal procedures. Although considered minimally invasive these procedures possess inherent potential danger. Pain management procedures involve manipulation of needles and devices very near spinal neural structures including the spinal cord, nerve roots and their blood supply. As a result, there is intrinsic danger involved in these procedures that can be induced by patient movement during critical points of the procedure. In addition, cardiac abnormalities such as local anesthetic induced hypotension, local anesthetic toxicity due to vascular absorption, vasovagal reactions, and cardiac arrhythmias and ST wave depression due to cardiac ischemia may occur during these procedures. The latter potential cardiac events many times are induced by fear and anxiety felt by patients presenting for these procedures.
Many patients who suffer from chronic pain and present for these therapies happen to be elderly and often times are Medicare patients. The advanced age of these patients is associated with co-morbid medical conditions such as hypertension, coronary artery disease, diabetes, obesity, sleep apnea, pulmonary, renal, and liver disease. Medical comorbidities are associated with increased perioperative complications and thus warrant additional anesthetic attention. In addition to the medical evidence supporting anesthesia monitoring during spinal procedures, one must take into account the overall patient experience.
The utilization of MAC anesthesia services as a standard of care shows an overwhelming support by patients who receive it. Fewer complications including cardiac arrhythmia and ST changes are also noted. Utilizing MAC anesthesia does not equate to deep sedation as it is critical to maintain responsiveness from the patient to ensure no spinal injury. Call Strategy Anesthesia, as it is important to have an anesthesia professional experienced in administering light to moderate conscious sedation to patients undergoing spinal procedures. Strategy Anesthesia provides anesthesia services to several pain management practices across the nation. A skilled professional will relax the patient while maintaining responsiveness from the patient. Without skilled anesthesia providers, many pain practitioners are administering IV conscious sedation medications themselves without the same level of patient monitoring or management. These IV drugs have longer half-lives and are associated with post-procedure side effects like nausea, vomiting and sedation, especially in the elderly who often have delayed renal and liver clearance. Propofol, when titrated appropriately is an excellent alternative, as it is rapidly metabolized and eliminated completely from the body within fifteen to twenty minutes. It is also safer as well as more acceptable by the patients and a better standard of care to which Medicare patients should have access. Ultimately, the decision to or not to utilize MAC anesthesia should be left to the physician and should be an integral part of the patient-physician relationship.