Intraoperative invasive/minimally invasive hemodynamic monitoring techniques consistent with institutional standards may be used in patients undergoing complex spine surgeries. (C-EO, Class I)

Arterial waveform-based monitoring may be useful to guide intraoperative fluid responsiveness.(B-NR, Class IIb)

Invasive arterial blood pressure monitoring is reasonable for complex spine surgery. (C-EO, Class IIa)

Lung-protective ventilation (6 to 8 mL/kg ideal body weight) has not been shown to confer benefit when in a prone position but is not harmful. (B-R, Class III)

To lower peak airway pressure, improve oxygenation and reduce the risk of surgical bleeding, pressurecontrolled ventilation may be considered rather than volume-controlled ventilation. No evidence was foundregarding the impact of the mode of ventilation on length of stay, or quality of recovery after spine surgery. (B-R, Class IIa)

Higher levels of positive end-expiratory pressure (9 to 12 cmH2O) may be required to maintain compliance and regional ventilation in the prone position. (B-R, Class IIa)

The Jackson surgical table should be used whenever possible to reduce intra-abdominal pressure and improve intraoperative oxygenation in the prone position. (B-R, Class I)

Hemoglobin and hematocrit values should be monitored frequently (every 1 to 2 h or more often on a case-by-case basis) during complex spine procedures. (C-EO, Class I)

If MEPs are monitored, dexmedetomidine should be used in doses <0.8 mcg/kg/h to prevent interference with MEPs. (B-R, Class IIa)

Methadone can be a useful adjunct to TIVA or inhalational anesthetic regimens to reduce pain and opioid requirements(B-R, Class IIa)