An Overview on Propofol–Fentanyl Anesthesia for Complex Spine Surgery

Abstract

Background: Complex spine surgery often requires prolonged anesthesia, stable hemodynamic control, effective analgesia, rapid recovery, and preservation of intraoperative neurophysiological monitoring. Propofol is a widely used intravenous hypnotic because of its favorable pharmacokinetic and pharmacodynamic profile, rapid onset and recovery, low incidence of postoperative nausea and vomiting, and suitability for total intravenous anesthesia and neurosurgical procedures. It also decreases cerebral blood flow, intracranial pressure, and cerebral metabolic rate, while remaining generally compatible with evoked-potential monitoring. However, propofol may produce dose-dependent cardiovascular depression, particularly hypotension and bradycardia. Fentanyl is a potent synthetic μ-opioid receptor agonist commonly used as an analgesic and anesthetic adjunct. In neuroanesthesia, it provides effective analgesia and attenuates sympathetic responses to laryngoscopy and surgical stimulation, while having relatively limited direct effects on somatosensory and motor evoked-potential monitoring at usual anesthetic doses. Nevertheless, careful titration is necessary because excessive fentanyl administration can cause respiratory depression, hypercapnia, hypotension, and other opioid-related adverse effects. The complementary hypnotic properties of propofol and potent analgesic effects of fentanyl therefore make their combination relevant to anesthetic management during complex spine surgery.