Publications by authors named "Matthew Kanter"
Background: Hyponatremia is a common complication following endoscopic endonasal resection (EER) of pituitary adenomas. We report a single-center, multisurgeon study detailing baseline clinical data, outcomes, and factors associated with postoperative hyponatremia.
Methods: This was a retrospective cohort study of patients undergoing EER for pituitary adenoma at Tufts Medical Center.
Background: Spinal anesthesia (SA) is used in lumbar surgery, but initial adequate analgesia fails in some patients. In these cases, spinal redosing or conversion to general endotracheal anesthesia is required, both of which are detrimental to the patient experience and surgical workflow.
Methods: We reviewed cases of lumbar surgery performed under SA from 2017-2021.
Article Synopsis
- The erector spinae plane block (ESPB) is an emerging technique for regional pain relief in lumbar surgery, aiming to enhance recovery by minimizing hospital stays and opioid use.
- The study involved neurosurgeons using fluoroscopic guidance to perform the ESPB on 21 patients, showing an average procedure time of just 1.2 minutes and effective anesthetic spread along the targeted area.
- Fluoroscopic guidance proves to be a valuable method for spine surgeons, increasing the efficiency of administering the ESPB and reducing reliance on anesthesiology specialists.
Article Synopsis
- - The study investigates the impact of spinal anesthesia (SA) on reducing the use of multiple medications (polypharmacy) and opioid consumption in elderly patients (≥65 years) undergoing a specific spine surgery called transforaminal lumbar interbody fusion (TLIF) compared to general anesthesia (GA).
- - Results show that patients receiving SA averaged 7.45 medications, significantly fewer than the 12.7 medications for those under GA, and had a much lower average opioid consumption (5.17 MME for SA vs. 20.2 MME for GA).
- - The findings suggest that SA not only minimizes polypharmacy but may also lessen the need for opioid pain management; however, further studies are needed
Article Synopsis
- Greater thecal sac volumes are linked to higher risks of spinal anesthesia (SA) failure, but measuring the cross-sectional area of the thecal sac can help tailor bupivacaine doses to improve outcomes.
- A study with 80 lumbar surgery patients adjusted bupivacaine doses based on thecal sac area measurements, finding that none experienced SA failure, compared to a 5.6% failure rate in a control group who received a standard dose.
- The results suggest that personalized SA dosing based on the thecal sac area effectively minimizes anesthesia failures and no significant adverse outcomes were reported in the personalized dosage group.
Article Synopsis
- * A study analyzed MRI measurements from 80 patients to see if cross-sectional area could predict thecal sac volume, finding that the area correlates with volume across lumbar levels.
- * Results showed that the L4-L5 level's cross-sectional area most accurately indicates total thecal sac volume, suggesting it could serve as a reliable proxy in clinical settings.
Article Synopsis
- Spinal anesthesia is underused in lumbar surgeries despite its proven safety and benefits, like lower costs and reduced recovery time compared to general anesthesia.
- This study compares spinal and general anesthesia's accessibility and climate impact, analyzing cost savings and carbon emissions associated with spinal fusions in various countries.
- Findings indicate that using spinal anesthesia could save the U.S. $343 million and significantly reduce carbon emissions, highlighting its potential benefits for both healthcare and the environment.
Spinal stenosis is one of the most common neurosurgical diseases and a leading cause of pain and disability. Wild-type transthyretin amyloid (ATTRwt) has been found in the ligamentum flavum (LF) of a significant subset of patients with spinal stenosis who undergo decompression surgery. Histologic and biochemical analyses of LF specimens from spinal stenosis patients, normally discarded as waste, have the potential to help elucidate the underlying pathophysiology of spinal stenosis and possibly allow for medical treatment of stenosis and screening for other systemic diseases.
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- Spinal anesthesia is safe for lumbar surgeries, even for patients with comorbidities like obesity, anxiety, and sleep apnea, challenging the notion that these factors increase complication risks.
- A study analyzed 422 lumbar surgeries performed under spinal anesthesia, finding no significant differences in complications across various risk factor groups compared to a control group.
- The findings suggest that spinal anesthesia can be a viable option for most patients with significant comorbidities, supporting its broader use in routine lumbar procedures.
Article Synopsis
- Triggered electromyography (tEMG) is used during spinal surgery to check the placement of pedicle screws, but there are concerns about its effectiveness when patients are under spinal anesthesia instead of general anesthesia.
- A study with 23 patients compared the nerve thresholds during lumbar fusion surgeries performed with either spinal or general anesthesia, and found no significant differences in the nerve threshold responses between the two groups.
- The results suggest that spinal anesthesia can be safely used with tEMG for monitoring during pedicle screw placement, meaning it doesn't hinder the effectiveness of the technique.
A Second Prone Dose Algorithm for Patients Undergoing Spinal Anesthesia During Thoracolumbar Surgeries.
Oper Neurosurg (Hagerstown)
March 2023
Background: Spinal anesthesia is safe and effective in lumbar surgeries, with numerous advantages over general anesthesia (GA). Nevertheless, 1 major concern preventing the widespread adoption of this anesthetic modality in spine surgeries is the potential for intraprocedural anesthetic failure, resulting in the need to convert to GA intraoperatively.
Objective: To present a novel additional prone dose algorithm for when a first spinal dose fails to achieve the necessary effect.
Background: Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Although POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others.
View Article and Find Full Text PDFBackground: Postoperative pain is a barrier to early mobility and discharge after lumbar surgery. Liposomal bupivacaine (LB) has been shown to decrease postoperative pain and narcotic consumption after transforaminal lumbar interbody fusions (TLIFs) when injected into the marginal suprafascial/subfascial plane-liposomal bupivacaine (MSSP-LB). Erector spinae plane (ESP) infiltration is a relatively new analgesic technique that may offer additional benefits when performed in addition to MSSP-LB.
View Article and Find Full Text PDFObjective: Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD) is a devastating complication. Demographic risk factors for ICH in LVAD patients are defined, however anatomic predispositions to ICH are unknown. We sought to interrogate intracranial radiographic risk factors for ICH in LVAD patients.
View Article and Find Full Text PDFObjective: Postoperative urinary retention (POUR) is a common and vexing complication in elective spine surgery. Efficacious prevention strategies are still lacking, and existing studies focus primarily on identifying risk factors. Spinal anesthesia has become an attractive alternative to general anesthesia in elective lumbar surgery, with the potential of having a differential impact on POUR.
View Article and Find Full Text PDFObjective: Wild-type transthyretin amyloid (ATTRwt) is deposited in the ligamentum flavum (LF) of a subset of patients with spinal stenosis who undergo decompressive surgery, although its role in the pathophysiology of spinal stenosis is unknown. It has been theorized that degeneration of intervertebral discs causes increased mechanical stress and inflammatory/degenerative cascades and ultimately leads to LF fibrosis. If ATTRwt deposits contribute to LF thickening and spinal stenosis through a different pathway, then patients with ATTRwt may have less severe disc degeneration than those without it.
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