Post-endoscopy Subarachnoid Hypertension Syndrome: A Case Series in the Recovery Period After Unilateral Biportal Endoscopic Surgery Under General Anesthesia

Background Post-endoscopy subarachnoid hypertension syndrome (PESHS) is a rare but potentially serious complication following spinal endoscopic surgery. Although most reported cases have occurred after percutaneous endoscopic lumbar discectomy (PELD), PESHS after unilateral biportal endoscopic (UBE) surgery remains poorly characterized, and standardized diagnostic and management strategies are lacking. This study aimed to describe the clinical features, management, and outcomes of PESHS in patients recovering from UBE surgery. Case presentation: Three patients developed PESHS in the post-anesthesia care unit (PACU) following UBE procedures under general anesthesia. Presenting manifestations included severe headache, acute hypertension, and transient neurological deficits. Early recognition prompted immediate implementation of dehydration therapy and spinal cord decompression maneuvers, combined with sedation, analgesia, and anti-inflammatory treatment. All patients showed clinical improvement within 2–5 h and were subsequently transferred to the ward for continued monitoring. Integrated care based on “early monitoring–targeted intervention–refined nursing” was applied throughout management. Conclusion A comprehensive understanding of PESHS enables prompt identification and effective mitigation of this complication. The present cases highlight the feasibility of a structured approach encompassing vigilant perioperative monitoring, timely targeted interventions, and meticulous nursing care. These findings offer a practical framework for the diagnosis, treatment, and nursing management of UBE-associated PESHS.