Eun Seok Ka, M.D., Gong Min Rim, M.D., Seungyoun Kang, M.D., Saemi Bae, M.D., Il-Tae Jang, M.D., Hyung Joo Park, Ph.D., M.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.23.139

This study aimed to categorize contrast media images associated with epidural, subdural, and combined epidural–subdural anesthesia in patients who had undergone fluoroscopy-guided epidural anesthesia using contrast media combined with monitored anesthesia care (MAC) targeted at deep sedation, incorporating capnography over 5 years. Additionally, a correlation was established between the anesthetic effects and radiographic findings according to the categorized imaging appearances. This study included 628 patients who underwent endoscopic, open, or fusion surgery under epidural anesthesia at Nanoori Hospital in Gangnam between March 2018 and September 2023. Fluoroscopy-guided epidural anesthesia using contrast media combined with MAC and capnography was used. The dataset included detailed radiographic imaging, nursing, and anesthesia records. Distinct patterns of anesthesia administration were observed, with 49%, 19.6%, and 31% of patients receiving epidural, subdural, and combined epidural–subdural anesthesia, respectively. The incidence and duration of motor block were significantly different among the three groups. Additionally, subdural anesthesia displayed a higher incidence of motor block and a prolonged motor deficit duration than epidural anesthesia. Fluoroscopic guidance using a contrast medium for epidural and subdural anesthesia ensures precise space identification and prevents serious anesthetic complications. Our findings suggest the potential to achieve stable anesthesia, particularly using subdural and combined epidural–subdural anesthesia.

Background: In this study, based on machine-learning technology, we aim to develop a predictive model of the short-term prognosis of Korean patients who received spinal stenosis surgery. Methods: Using the data obtained from 112 patients with spinal stenosis admitted at N hospital from February to November, 2019, a predictive analysis was conducted for the pain index, reoperation, and surgery time. Results: Results show that the predicted area under the curve was 0.803, 0.887, and 0.896 for the pain index, reoperation, and surgery time, respectively, thereby indicating the accuracy of the model. Conclusion: This study verified that the individual characteristics of the patient and treatment characteristics during surgery enable a prediction of the patient prognosis and validate the accuracy of the approach. Further studies should be conducted to extend the scope of this research by incorporating a larger and more accurate dataset.

Response to Letter in regards to Letter to the Editor Regarding “Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery” [Letter]

Purpose: This study examines the hemodynamic responses elicited by epidural, subdural, and combined epidural-subdural anesthesia during spinal surgery, with a focus on anesthetic levels and ASA classifications. It integrates image findings to enhance understanding of the anesthetic impact on hemodynamic stability. Patients and Methods: A retrospective analysis was conducted involving patients who underwent endoscopic, open, or fusion spine surgeries with epidural anesthesia and monitored anesthesia care (MAC) between March 2018 and September 2023. Comprehensive demographic data, details regarding anesthetic levels, ASA class and hemodynamic measurements were systematically collected. Additionally, fluoroscopic images were assessed to investigate the distribution patterns of anesthetics and their relationship to hemodynamic outcomes. Results: In patients undergoing epidural, subdural, and combined epidural-subdural anesthesia with high-level blocks above T5 and classified as ASA class III or higher, no significant differences were observed in hypotensive events or vasopressor usage compared to those with lower-level blocks or ASA classifications. The mean duration of surgery was 90.6 ± 40.9, 105.4 ± 42.5, and 100.8 ± 46.6 minutes, respectively, across the three groups. Subdural anesthesia exhibited a similar hemodynamic profile, with milder blood pressure decreases. Imaging analysis indicated distinct anesthetic distribution patterns primarily in the posterior epidural and subdural spaces, which helped preserve anterior sympathetic and motor functions, suggesting a relationship between fluoroscopic imaging features and hemodynamic stability. Conclusion: Hemodynamic stability was maintained in the subdural and combined epidural-subdural groups compared to the epidural group in ASA I to III patients. However, epidural anesthesia showed better hemodynamic outcomes for ASA class above III. High-level epidural and subdural anesthesia primarily induced posterior diffusion, resulting in minimal anterior sympathetic block while preserving stability. These findings suggest that epidural anesthesia may be a viable alternative for spinal surgeries and applicable to other procedures for patients with high ASA classifications.