Hyperbaric oxygenation therapy treatment option in perioperative visual loss in spine surgery

<p class="abstract">Perioperative vision loss (POVL) is a catastrophic complication of spine surgery and several risk factors are identified. As spine fusion surgery is rising in number, POVL incidence is increasing. Preventive strategies can decrease the risk of this complication. Prognosis depends on the level of occlusion and how quickly oxygen supply can be restored to retina. We present a 65-year-old female patient with multiple cardiovascular risk factors that who underwent lumbar fusion. Upon waking up from anesthesia, the patient reported total loss of vision in her left eye. An occlusion of the central retinal artery due to a probable embolic cause was diagnosed and the patient promptly started treatment with anti-aggregation therapy and hyperbaric oxygen therapy (HBOT) with good results. The combination of HBOT with anti-aggregation therapy may have had a synergistic effect contributing to the good outcome presented in this case and may be a good option for the treatment of this patients. </p>

Checking the integrity of eyes in prone position: A novel application of video laryngoscopes

Perioperative visual loss is a rare but severe complication after surgery in prone position. One of several mechanisms is direct ophthalmic compression. This can be avoided through optimal positioning and padding of the head, but position and integrity of the eyes need to be checked at regular intervals. We describe the use of a conventional video laryngoscope during vascular surgery in prone position as a simple solution for intermittent monitoring of external integrity of the eyes and size of the pupils. This requires no additional material and allows documentation of the findings. Our method might reduce complications and improve patient outcome.

Post Appendectomy Blindness, Extremely rare complication after abdominal surgery

Perioperative visual loss (POVL) is a drastic complication that can result after ocular and more commonly non-ocular surgery, mostly reported after spine and cardiac bypass procedures. Despite the rarity of such complication, it has been reported following the abdominal surgeries. Overall, the most common cause of POVL is ischemic optic neuropathy but any pathology to the optical system from the cornea to the occipital lobe can lead to this rare phenomenon. Here, we are reporting the second case in the literature of post-operative visual loss after laparoscopic appendectomy. A young female, with no underlying disease, underwent laparoscopic appendectomy after septic shock secondary to acute appendicitis. Postoperatively, patient complained of complete blindness after extubation. Neurologic examination revealed bilateral near complete blindness, and hemodynamic ischemic stroke in the occipital cortex.

Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study

Prone positioning is frequently used for spinal surgery and is associated with risks including perioperative visual loss and stroke. Frequent eye checks and careful neck positioning are recommended. In our hospital’s current model, anesthesia providers are required to kneel on the operating room floor beneath operating room table, exposing themselves to hazards such as bodily fluids and back and knee strain. This maneuver is both time consuming and unpleasant. While new devices that enable easier visualization of patients in the prone position exist, they are costly and not universally compatible with all operating room tables. Our objective for this feasibility pilot study was to determine if simple, extendable mirrors increase anesthetist comfort during these cases. A nonrandomized survey-based feasibility pilot study was performed, evaluating comfort while performing eye checks with extendable lighted mirrors compared to the standard kneeling practice. A total of 41 nurse anesthetists and anesthesiology residents were analyzed. A mixed model logistic regression demonstrates a three-fold improvement in comfort with the prone position after mirror use (OR = 3.34; 95% CI: 1.06–10.48; p = 0.039). The frequency of eye checks did not change significantly with introduction of the mirror. Use of the extendable mirror improves anesthesia provider comfort with patients in the prone position. We postulate that it may be a useful addition to our practice.

Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019

Supplemental Digital Content is available in the text.

Evaluating the Variation of Intraocular Pressure With Positional Change During Colorectal Laparoscopic Surgery: Observational Study (Preprint)

BACKGROUND The incidence of perioperative visual loss following colorectal surgery in the US is quoted as 1.24 per 10,000. Raised intraocular pressure (IOP) during extreme Trendelenburg position leading to reduced optic nerve perfusion is thought to be a cause. OBJECTIVE To assess the effect of the degree of Trendelenburg tilt and time spent in Trendelenburg on IOP during laparoscopic colorectal surgery. METHODS Fifty patients undergoing laparoscopic colorectal surgery were recruited. A Tonopen XL applanation tonometer was used to take IOP measurements hourly during surgery, and each time the operating table was tilted. A correlation coefficient for the degree of Trendelenburg tilt and IOP was calculated for each patient. Group 1 included patients undergoing a right-sided colonic procedure, and Group 2 included all left-sided colonic operations. RESULTS The mean age of Group 1 participants (n=25) was 69 years (SD 14), and Group 2 (n=25) was 63 years (SD 16; P>.05). The average length of surgery for Group 1 was 142 minutes (SD 48), and Group 2 was 268 minutes (SD 99; P≤.05). The mean maximum degree of Trendelenburg tilt in Group 1 was 10 (SD 7) and Group 2 was 19 (SD 6; P≤.05). The mean IOP increase was 9 mm Hg (SD 5) for Group 1 and 15 mm Hg (SD 5) in Group 2 (P≤.05). An overall correlation coefficient for the degree of Trendelenburg tilt and IOP change (n=48) was .78. CONCLUSIONS There is a strong correlation between IOP elevation during laparoscopic colorectal surgery and the degree of Trendelenburg tilt. This may be significant for patients undergoing prolonged surgery and especially those with glaucoma.