Influence of Anesthetic Management on Neurological and Survival Outcomes in Patients Undergoing Emergency Surgery for Acute Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis

Background: Acute traumatic spinal cord injury (tSCI) represents a devastating condition with significant morbidity and mortality. Anesthetic management during emergency surgery may influence secondary injury cascades and subsequent neurological recovery through hemodynamic optimization, neuroprotective agent selection, and avoidance of physiological insults. However, the impact of specific anesthetic strategies on outcomes remains incompletely characterized.Objective: This systematic review and meta-analysis evaluated the association between anesthetic management strategies and neurological and survival outcomes in patients undergoing emergency surgery for acute tSCI.Methods: We systematically searched PubMed, Embase, and Cochrane Library databases from inception to January ۲۰۲۶ for studies comparing anesthetic approaches in adult patients undergoing emergency spinal decompression surgery following acute tSCI. Primary outcomes were neurological improvement measured by American Spinal Injury Association (ASIA) grade change and mortality. Pooled odds ratios (OR) with ۹۵% confidence intervals (CI) were calculated using random-effects models.Results: Twenty-three observational studies and ۲ randomized controlled trials encompassing ۴,۸۴۷ patients met inclusion criteria. Maintenance of mean arterial pressure (MAP) ≥۸۵ mmHg was associated with improved neurological outcomes (OR ۱.۵۸, ۹۵% CI ۱.۲۱–۲.۰۶; I²=۶۲.۳%). Hypotensive episodes (MAP <۷۰ mmHg for >۱۰ minutes) during the intraoperative period significantly increased mortality risk (OR ۲.۳۴, ۹۵% CI ۱.۶۷–۳.۲۸; I²=۴۸.۹%). Propofol-based total intravenous anesthesia was associated with lower odds of poor neurological recovery compared to volatile anesthetic-based regimens (OR ۰.۷۱, ۹۵% CI ۰.۵۴–۰.۹۳; I²=۴۱.۲%). The use of high-dose methylprednisolone demonstrated no significant benefit on neurological outcomes (OR ۱.۱۲, ۹۵% CI ۰.۸۹–۱.۴۱; I²=۵۴.۷%) but was associated with increased pulmonary complications (OR ۱.۴۲, ۹۵% CI ۱.۰۸–۱.۸۷).Conclusion: Hemodynamic optimization targeting MAP ≥۸۵ mmHg and avoidance of intraoperative hypotension are critical components of anesthetic management associated with improved outcomes in acute tSCI surgery. Anesthetic agent selection may influence neurological recovery, though evidence quality remains limited.

کلیدواژه ها:

Traumatic Spinal Cord Injury ، anesthetic management ، Mean Arterial Pressure ، neurological outcomes ، Perioperative Care