Intravenous antifibrinolytics such as tranexamic acid (bolus followed by an infusion) are beneficial in reducing intraoperative blood loss and are indicated in complex spine surgeries. (A, Class I)

Cell salvage may be considered to reduce red blood cell transfusion requirement in patients undergoing complex spine procedures at risk for blood loss. (A, Class III)

Preoperative blood donation may be considered for selected patients undergoing complex spine procedures.(B-NR, Class IIb)

No specific recommendation can be made for transfusion thresholds or transfusion ratios.(B-NR,Class IIb)

Anesthesiologists should consider the amount and rapidity of blood loss, the concurrent fluid/acid-base/coagulation profiles, systemic perfusion pressure, and end-organ function in informing perioperative transfusion thresholds ratios. (C-EO, Class I)

Higher ambient temperature before the patient arrives in the oped warmers are reasonable techniques to maintain normothermia. (B-R, Class IIa)

Normothermia should be maintained (core temperature of >36°C) in the perioperative period.(C, Class I)

A multimodal analgesic approach may be considered, but a specific regimen cannot be recommended from the literature. (B-R, Class IIb)

Alpha-2 agonists (clonidine/dexmedetomidine) can be useful analgesic adjuncts during TIVA or inhalational anesthesia to reduce dosing of other agents and opioids, improve postoperative pain, and to reduce PONV. (B-R, Class IIa)

Acupressure point therapy may be considered as an adjunct in a multimodal analgesic regimen. (B-R, Class IIb)