|
1
|
Gabbay J, Walter E, Kerman T, Amitai N, Gabay O, Hazan I, Abuhasira R, Tsumi E. Hypoperfusion states could increase the risk of non-arteritic anterior ischemic optic neuropathy. PLoS One 2024; 19:e0313098. [PMID: 39585890 PMCID: PMC11588264 DOI: 10.1371/journal.pone.0313098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 10/18/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Non-arteritic anterior ischemic optic neuropathy (NAION) is a leading cause of acute optic nerve damage. While cardiovascular risk factors such as hypertension, diabetes mellitus, and obstructive sleep apnea are well-established, the association between NAION and states of hypoperfusion is underexplored. This study investigated this potential association. METHODS This retrospective case-control study analyzed all electronic medical records of Clalit Health Services' patients from 2001 to 2022. Patients diagnosed with NAION were matched in a 1:4 ratio by year of birth and sex, using propensity score analysis to adjust for various comorbidities. Events of hypoperfusion occurring in the month prior to the diagnosis of NAION were categorized into two physiological mechanisms: a decrease in SVR and a decrease in cardiac output due to cardiac dysfunction or diminished preload (attributed to hypovolemia). Conditional logistic regression was used to explore differences between the groups. RESULTS A total of 1,374 patients diagnosed with NAION and 5,496 matched controls were included in the study. We found a nearly 6.5-fold increase in the likelihood of NAION in association with events of hypoperfusion that occurred in the month period preceding the diagnosis of NAION (odds ratio [OR] 6.48; 95% confidence interval [CI]: 5.05-8.32). In particular, the group of patients with cardiac dysfunction (OR 6.47; 95% CI: 4.63-9.04) and the group with hypovolemia (OR 6.1; 95% CI: 4.08-9.13) emerged as having the most substantial risk factors. The group with decreased Systemic Vascular Resistance (SVR) (OR 4.64; 95% CI: 2.84-7.59) was also strongly related with NAION. Cerebrovascular accident emerged as an independent significant risk factor for NAION (OR 16.1; 95% CI: 10.8-24). CONCLUSION Hypoperfusion states are significant, independent risk factors for NAION.
Collapse
Affiliation(s)
- Jasmin Gabbay
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Eyal Walter
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Tomer Kerman
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Nir Amitai
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Ohad Gabay
- Department of Intensive Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Itai Hazan
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| |
Collapse
|
|
2
|
Shaikh N, Nahid S, Ummunnisa F, Amara UE, Nasrah U, Fatima A, Shareef F, Balal AR. Reversible postoperative vision loss (POVL): A tale of four patients. Qatar Med J 2024; 2024:37. [PMID: 39429722 PMCID: PMC11490035 DOI: 10.5339/qmj.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/09/2024] [Indexed: 10/22/2024] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is a clinic-imaging entity. PRES is rarely reported in the perioperative period to cause reversible postoperative vision loss (POVL). It is reported in the literature in the form of case reports for spinal and cardiac surgeries and eclampsia patients. The suggested diagnostic criteria for PRES are: (i) acute onset of neurological symptoms and signs; (ii) specific findings of vasogenic cerebral edema upon imaging studies; and (iii) reversibility of signs and symptoms as well as image study findings. We report a case series of four patients undergoing other than spinal, cardiac, or orthopedic surgeries who developed PRES and had reversible POVL. Cases The first case was a young female who had laparoscopic sleeve gastrectomy, had extreme hypertension at induction of anesthesia, had surgery and developed POVL after a few hours in the postoperative period, and had convulsions diagnosed to have PRES after computed tomography (CT) and magnetic resonance imaging (MRI). Managed with blood pressure and seizure control, vision returned gradually from 2nd postoperative day. The second case was also a young female who had appendicitis, requiring an appendectomy. Complicated by septic shock. Post-surgery, she was extubated after 1 day and immediately complained of total blindness. Local causes were ruled out, and an MRI diagnosed PRES. With supportive therapy, her vision started to return by Day 3 with improved normal vision. The third case was a female with recently diagnosed diabetes mellitus who presented with right upper limb embolic ischemia and had an embolectomy with a return of circulation. Her blood pressure was high and reached up to 200 mmHg after induction of anesthesia, which was controlled with deep anesthesia and a labetalol infusion in the perioperative period. After 8 h in the postoperative period, she was awake but searching for available objects. Relatives complained that she was unable to see. Local and fundus examinations were normal. She was awake but blind. Imaging studies confirmed PRES. Blood pressure was controlled using a labetalol infusion and continued supportive therapy. By Day 3, her vision became normal. The fourth case was an elderly patient who had hypertension, type 2 diabetes mellitus, and coronary artery disease. He underwent a right carotid endarterectomy under general anesthesia. He had severe hypertension in the perioperative area and blood pressure was controlled using a labetalol infusion. The surgery went smoothly. After 3 h, he had a loss of vision. Imaging studies confirmed PRES. His blood pressure was kept normal. After 2 days, his vision gradually returned to normal. Follow-up MRIs in the outpatient clinic for all four patients normalized in due time. Conclusion Extremes of hypertension and/or hypotension in the perioperative period can cause PRES, which may lead to reversible POVL.
Collapse
Affiliation(s)
| | | | | | - Umm E Amara
- Apollo Institute of Medical Sciences, Hyderabad, India
| | | | - Azha Fatima
- Kamineni Institute of Medical Sciences, Hyderabad, India
| | | | | |
Collapse
|
|
3
|
Urzedo ABDL, Almeida GB, Hokazono K. Incipient and Established Anterior Ischemic Optic Neuropathy Following Liposuction Surgery. Neuroophthalmology 2024; 49:179-184. [PMID: 40051719 PMCID: PMC11881879 DOI: 10.1080/01658107.2024.2397038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/01/2024] [Accepted: 08/22/2024] [Indexed: 03/09/2025] Open
Abstract
Ischemic optic neuropathy is a severe condition causing perioperative visual loss that may occur after a wide range of non-ocular surgeries, including liposuction. Several cases of non-arteritic anterior ischemic optic neuropathy (NAION) as a complication of liposuction have been published. Most have features in common such as anemia and altitudinal visual field defects. We report a case of incipient NAION in one eye and established NAION in the fellow eye after abdominoplasty, mastopexy, and large-volume liposuction, which complicated with anemia, but visual function recovered.
Collapse
Affiliation(s)
| | | | - Kenzo Hokazono
- Department of Ophthalmology, Universidade Federal do Paraná – HC-UFPR, Curitiba, Brazil
| |
Collapse
|
|
4
|
Michels N, Fantin R. [Perioperative visual loss : Rare, unknown, relevant?]. DIE ANAESTHESIOLOGIE 2024; 73:279-290. [PMID: 38587618 DOI: 10.1007/s00101-024-01398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Perioperative visual loss (POVL) is a rare but severe complication following non-ophthalmological surgery under general anesthesia. A POVL can be caused by lesions in any part of the optical system. The predominant causes include corneal injuries and particularly ischemic damage. The symptoms of POVL substantially vary ranging from reduced vision to complete blindness. The risks involve factors related to the surgery as well as patient-specific factors. In general, the prognosis in cases of mechanical damage is better than for ischemic lesions. The treatment measures depend on the underlying pathomechanism and due to the limited evidence only a few treatment options are available. Therefore, preventive measures and meticulous documentation play a crucial role.
Collapse
Affiliation(s)
- Nicolina Michels
- Universitätsklinik für Anästhesie und Intensivmedizin, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Raffaella Fantin
- Universitätsklinik für Anästhesie und Intensivmedizin, Anichstraße 35, 6020, Innsbruck, Österreich.
| |
Collapse
|
|
5
|
Rabinowitz J, Kinnear N, O'Callaghan M, Hennessey D, Shafi F, Fuller A, Ibrahim M, Lane T, Adshead J, Vasdev N. Systematic review of the ophthalmic complications of robotic-assisted laparoscopic prostatectomy. J Robot Surg 2024; 18:46. [PMID: 38240959 DOI: 10.1007/s11701-023-01771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.
Collapse
Affiliation(s)
| | - Ned Kinnear
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK.
- Flinders Medical Centre, Adelaide, Australia.
| | - Michael O'Callaghan
- Flinders Medical Centre, Adelaide, Australia
- Flinders University, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | | | - Fariha Shafi
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | | | | | - Timothy Lane
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - James Adshead
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Nikhil Vasdev
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
- University of Hertfordshire, Hatfield, UK
| |
Collapse
|
|
6
|
Pitsika M, Paschou VM, Pollard R, Nissen JJ. Perioperative visual loss and consent for adult spine surgery: a national survey of the practice amongst spine surgeons and anaesthetists †. Br J Neurosurg 2023:1-8. [PMID: 37943103 DOI: 10.1080/02688697.2023.2275621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Perioperative Visual Loss (POVL) is a devastating complication for patients undergoing spine surgery. Consent process for POVL amongst spine surgeons and anaesthetist remains variable. The aim of this study is to evaluate their practice and views about it. METHODS Two similar questionnaires were distributed to members of the Society of British Neurological Surgeons (SBNS), British Association of Spine Surgeons (BASS), and Neuroanaesthsia and Critical Care Society (NACCS). RESULTS A total of 271 responses were received (SBNS/BASS n = 149, NACCS n = 122). Fewer surgeons considered POVL as a material risk for patients compared to the anaesthetists (57.7 versus 79.7%). Outpatient/pre-assessment clinics were considered as the optimal setting for discussing POVL by the majority of the clinicians (81.2 and 93.4%). POVL should be discussed by both specialists according to 75% of the anaesthetists. Estimated incidence of POVL was considered to be higher by the anaesthetists (0.03-0.2% by 63% of the anaesthetist versus 0.0001-0.004% by 57% of the surgeons). Twenty-three surgeons and 10 anaesthetists had a patient who suffered from POVL, which led to a change of practice in most of them. This questionnaire will lead to a change in practice/consent to 18.1% of the surgeons and 23.5% of the anaesthetists. CONCLUSIONS Most of the surgeons and anaesthetist feel that POVL is a material risk that ideally needs to be firstly discussed before the day of surgery, by both specialties. However, a significant number of clinicians have an opposite view. A national guidance from respective societies should encourage POVL to be discussed routinely.
Collapse
Affiliation(s)
- Marina Pitsika
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | | | - Rachel Pollard
- Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Justin J Nissen
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| |
Collapse
|
|
7
|
Shi C, Wang Z, Lin M, Chen Z, Xu P, Li Y, Zhang J. Cortical blindness after percutaneous vertebroplasty: a case report and comprehensive review of the literature. Neurocase 2023; 29:99-102. [PMID: 38687124 DOI: 10.1080/13554794.2024.2346984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Many complications but cortical blindness after percutaneous vertebroplasty has been rarely reported. Here, we describe a case who developed cortical blindness after percutaneous vertebroplasty. We also reviewed the literature to find the possible causes of this complication and its treatment. METHODS Case report and literature review. RESULTS A 71-year-old woman experienced cortical blindness after percutaneous vertebroplast. She developed dizziness, nausea, sweating, blood pressure changes, and vision loss during the procedure. MRI confirmed bilateral cerebral infarctions. The patient recovered with conservative treatment. CONCLUSIONS Percutaneous vertebroplasty, though helpful, carries a rare risk of cortical blindness. Surgeon awareness is crucial for informing patients of this potential complication.
Collapse
Affiliation(s)
- Chunnan Shi
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Zhijie Wang
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Meiying Lin
- Department of Ophthalmology, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Zhiqin Chen
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Peiyang Xu
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Yi Li
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| | - Jinshan Zhang
- Department of Orthopedics, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
| |
Collapse
|
|
8
|
Yang XY, Wei MM, Tan H, Wang HL, Luo MQ, Xu M, Wang YW. The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial. Perioper Med (Lond) 2023; 12:23. [PMID: 37308905 DOI: 10.1186/s13741-023-00310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/08/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Elevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position. METHODS A single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer's lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13-16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position. RESULTS A total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05). CONCLUSIONS Compared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery. TRIAL REGISTRATION The study was registered in ClinicalTrials.gov ( https://clinicaltrials.gov ) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.
Collapse
Affiliation(s)
- Xiao-Yu Yang
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Miao-Miao Wei
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Hong Tan
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Hai-Lian Wang
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Meng-Qiang Luo
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Ming Xu
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Ying-Wei Wang
- Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| |
Collapse
|
|
9
|
Zhang AS, Osorio C, Stone BK, Hong J, Alsoof D, McDonald CL, Czerwein JK, Daniels AH. Complications of Lateral Decubitus Positioning During Orthopaedic Surgery. JBJS Rev 2023; 11:01874474-202306000-00006. [PMID: 37289916 DOI: 10.2106/jbjs.rvw.23.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
» Lateral decubitus positioning is a nonanatomical position used for multiple orthopaedic procedures to obtain adequate surgical exposure.» Unique ophthalmologic, musculoskeletal, neurovascular, and hemodynamic complications may arise inadvertently from positioning.» Orthopaedic surgeons should be aware of the possible complications that may manifest from placing patients in the lateral decubitus position to adequately prevent and to properly manage them.
Collapse
Affiliation(s)
- Andrew S Zhang
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin K Stone
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - James Hong
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christopher L McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - John K Czerwein
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| |
Collapse
|
|
10
|
Atasever AG, Salviz EA, Şentürk Çiftçi H, Bingül ES, Sivrikoz N, Erdem S, Savran Karadeniz M. The Effects of Lateral 45° Head-Down Position and Carbon Dioxide Pneumoperitoneum on the Optic Nerve Sheath Diameter in Patients Undergoing Laparoscopic Transperitoneal Nephrectomies: A Prospective Observational Study. J Laparoendosc Adv Surg Tech A 2023; 33:171-176. [PMID: 36036829 DOI: 10.1089/lap.2022.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study is to assess the extent of the increased intracranial pressure resulting from lateral decubitus and 45° downward positioning using sonographic optic nerve sheath diameter (ONSD) in patients undergoing laparoscopic transperitoneal nephrectomy. In addition, we evaluated the effect of the carbon dioxide pneumoperitoneum (CO2PP) on ONSD. Materials and Methods: Twenty-four adults were enrolled in this prospective observational study. Longitudinal and transverse ONSDs were measured for each eye by ocular ultrasonography. The values were noted in supine position (T0), 20 minutes after induction of anesthesia (T1), after insufflation of the abdomen in lateral 45° head-down position (T2), at 30-minute intervals during surgery (T3-T4-T5), during lateral 45° head-down position after CO2 exsufflation (T6), before awakening while supine (T7), and at postoperative 24th hour (T8). Hemodynamic and respiratory parameters were investigated at the measurement time points. Results: Average ONSD values for the lower eye was T0 = 4.27 ± 0.4 mm, T1 = 4.56 ± 0.6 mm, T2 = 4.84 ± 0.6 mm, T3 = 4.91 ± 0.4 mm, T4 = 4.99 ± 0.5 mm, T5 = 4.97 ± 0.5 mm T6 = 4.96 ± 0.5 mm, T7 = 4.76 ± 0.4 mm, T8 = 4.36 ± 0.5 mm and for the upper eye was T0 = 4.24 ± 0.4 mm, T1 = 4.39 ± 0.5 mm, T2 = 4.54 ± 0.5 mm, T3 = 4.60 ± 0.4 mm, T4 = 4.66 ± 0.4 mm, T5 = 4.72 ± 0.7 mm, T6 = 4.68 ± 0.4 mm, T7 = 4.52 ± 0.4 mm, T8 = 4.30 ± 0.4 mm (P < .001). Conclusion: In our study, we observed a significant increase in ONSD within minutes after the patient was placed in a head-down position. We also observed that the difference increased more with CO2PP and was proportional to the length of the surgery. We found that it regressed to initial levels at the postoperative 24th hour. Clinicaltrials.gov: NCT05185908.
Collapse
Affiliation(s)
- Ayşe Gülşah Atasever
- Department of Anesthesiology and Intensive Care, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - Emine Aysu Salviz
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hayriye Şentürk Çiftçi
- Department of Medical Biology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emre Sertaç Bingül
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nükhet Sivrikoz
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Meltem Savran Karadeniz
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
|
11
|
Shah SH, Xiao L, Chen YF, Moss HE, Rubin DS, Roth S. Perioperative Ischemic Optic Neuropathy after Cardiac Surgery: Development and Validation of a Preoperative Risk Prediction Model. J Cardiothorac Vasc Anesth 2022; 36:4266-4272. [PMID: 36114093 PMCID: PMC10874298 DOI: 10.1053/j.jvca.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies identified risk factors for ischemic optic neuropathy (ION) after cardiac surgery; however, there is no easy-to-use risk calculator for the physician to identify high-risk patients for ION before cardiac surgery. The authors sought to develop and validate a simple-to-use predictive model and calculator to assist with preoperative identification of risk and informed consent for this rare but serious complication. DESIGN Retrospective case-control study. SETTING Hospital discharge records. PATIENTS A total of 5,561,177 discharges in the National Inpatient Sample >18 years of age, with procedure codes for coronary artery bypass grafting, heart valve repair/replacement, or left ventricular assist device insertion. INTERVENTIONS All patients had undergone cardiac surgery. MEASUREMENTS AND MAIN RESULTS Known preoperative risk factors for ION after cardiac surgery were assessed to develop a risk score and prediction model. This model was validated internally using the split-sample method. There were 771 cases of ION among 5,561,177 patients in the National Inpatient Sample. The risk factors for ION used in the model were carotid artery stenosis, cataract, diabetic retinopathy, macular degeneration, glaucoma, male sex, and prior stroke; whereas uncomplicated diabetes decreased risk. With the internal validation, the predictive model had an area under the receiver operating characteristic curve of 0.66. A risk score cutoff ≥3 had 98.4% specificity. CONCLUSIONS This predictive model, based on previously identified preoperative factors, predicted risk of perioperative ION with a fair area under the receiver operating characteristic curve. This predictive model could enable screening to provide a more accurate risk assessment for ION, and consent process for cardiac surgery.
Collapse
Affiliation(s)
- Shikhar H Shah
- Department of Anesthesiology, Walter Reed National Military Medical Center, Washington, DC
| | - Lan Xiao
- Center for Community Engagement, Stanford University, Stanford, CA
| | - Yi-Fan Chen
- The Center for Clinical & Translational Sciences, University of Illinois at Chicago, Chicago, IL
| | - Heather E Moss
- Departments of Ophthalmology and Neurology and Neurologic Sciences, Stanford University, Stanford, CA
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, IL; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL.
| |
Collapse
|
|
12
|
Roth S, Moss HE, Vajaranant TS, Sweitzer B. Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery. Anesthesiology 2022; 137:620-643. [PMID: 36179149 PMCID: PMC9588701 DOI: 10.1097/aln.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.
Collapse
Affiliation(s)
- Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurologic Sciences, Stanford University, Palo Alto, California
| | - Thasarat Sutabutr Vajaranant
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - BobbieJean Sweitzer
- University of Virginia, Charlottesville, Virginia; Perioperative Medicine, Inova Health System, Falls Church, Virginia
| |
Collapse
|
|
13
|
Huang JY, Shih PC, Chen CT, Lin HY, Chien YJ, Wu MY, Chen CH, Chang CY. Effects of Short-Acting Opioids on Intraocular Pressure during General Anesthesia: Systematic Review and Network Meta-Analysis. Pharmaceuticals (Basel) 2022; 15:989. [PMID: 36015137 PMCID: PMC9412988 DOI: 10.3390/ph15080989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Intraocular pressure (IOP) is crucial to the well-being of eyes. During anesthesia, the administration of succinylcholine and endotracheal intubation are associated with an increase in IOP, which may be attenuated by short-acting opioids. However, the drug of choice among the commonly used short-acting opioids is unclear. This study aimed to evaluate the effects of fentanyl, sufentanil, alfentanil, and remifentanil on IOP measured after the administration of succinylcholine and after endotracheal intubation in patients undergoing general anesthesia. Five databases were searched. Randomized controlled trials (RCTs) that compared short-acting opioids and reported at least one of the clinical outcomes of interest were included. Nine RCTs with 357 patients were included. Remifentanil (1 μg kg-1) more effectively alleviated the increase in IOP than the placebo after the administration of succinylcholine [mean difference (MD) of IOP, -3.64; confidence interval (CI), -5.47 to -1.81 and after endotracheal intubation (MD, -9.71; CI, -11.91 to -7.51). Remifentanil (1 μg kg-1) ranked the best in terms of both attenuating the increase in IOP after the administration of succinylcholine [surface under the cumulative ranking curve (SUCRA), 0.91; normalized entropy (NE), 0.47; and after endotracheal intubation (SUCRA, 0.89; NE, 0.54) among all of the treatments. Remifentanil (1 μg kg-1) should be considered the drug of choice in the circumstances where increased IOP is a great concern.
Collapse
Affiliation(s)
- Jian-You Huang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Ping-Cheng Shih
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chu-Ting Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Han-Yu Lin
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yung-Jiun Chien
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Meng-Yu Wu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| |
Collapse
|
|
14
|
Sun Y, Wang J, Wang W, Fan G, Wu S, Zhao F, Lu Y, Liu D, Li Y, Hu J, Yang L, Bai Y, Zhao T, Zhao Y. Effect of different surgical positions on intraocular pressure: a cross-sectional study. BMC Ophthalmol 2022; 22:318. [PMID: 35883052 PMCID: PMC9317174 DOI: 10.1186/s12886-022-02547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intraoperative intraocular pressure (IOP) elevation is a risk factor for postoperative blindness. Surgical position is associated with intraoperative IOP elevation. In China, there are few studies on the effect of various surgical positions on intraoperative IOP. This study was conducted to explore IOP change and its related factors in four common surgical positions in China. Methods This was a cross-sectional observational study. A total of 325 surgical patients who had non-ocular surgery from January 2019 to December 2019 in the hospital, were enrolled in this study. During their surgeries for general anesthesia, these participants were placed in lithotomy position/lateral position/prone position/supine position according to their surgery requirement. IOP was measured by icareTA03 handheld portable tonometer at 9 different time points from admission to exiting the operation room. And general information, postural position, and surgery information were collected through a uniform questionnaire. Multivariate analysis was performed to explore the related factors of IOP change. Results IOP of both eyes on lithotomy position, lateral position, and supine position showed statistical differences by ANOVA test at each time point (p < 0.05). IOP of both eyes in the prone position before exit from the operating room was significantly higher than IOP 10-min after anesthesia (p < 0.01). IOP under different postural angles showed statistical differences (F value = 4.85, P < 0.05), and the larger the head-down angle, the higher the IOP. IOP on the compressed side in the lateral position was higher than that on the non-compressed side (p < 0.01). In the multivariate linear regression analysis adjusted by other factors, postural position and baseline IOP were associated with IOP difference between before and after surgery (p < 0.01). Conclusion IOP in the four surgical positions showed different change patterns with the surgical process and position change. Nurses should assist the surgeon to reduce the head-down angle without interfering with the surgical operation and strengthen the inspection of IOP on patients with long-time surgery, to avoid intraoperative rapid IOP changes.
Collapse
Affiliation(s)
- Yuhong Sun
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Juan Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Wei Wang
- Beijng Tongren Hospital, Beijing, 100730, People's Republic of China
| | - Guohui Fan
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Sinan Wu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology,, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yi Lu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Di Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Jin Hu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Lin Yang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yu Bai
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Tong Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Ying Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| |
Collapse
|
|
15
|
Boonstra FN, Bosch DGM, Geldof CJA, Stellingwerf C, Porro G. The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment. Front Hum Neurosci 2022; 16:727565. [PMID: 35845239 PMCID: PMC9280621 DOI: 10.3389/fnhum.2022.727565] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.
Collapse
Affiliation(s)
- Frouke N. Boonstra
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- *Correspondence: Frouke N. Boonstra,
| | | | - Christiaan J. A. Geldof
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Catharina Stellingwerf
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Giorgio Porro
- Department of Ophthalmology, UMC Utrecht and Amphia Hospital Breda, Breda, Netherlands
| |
Collapse
|
|
16
|
Epidemiology of postoperative visual loss for non-ocular surgery in a cohort of inpatients. Eye (Lond) 2022; 36:1323-1325. [PMID: 34799706 PMCID: PMC9151637 DOI: 10.1038/s41433-021-01791-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 11/09/2022] Open
|
|
17
|
Phillipps S, Schiborra F, Nagendran A. Late‐onset seizures in a domestic shorthaired cat with global brain ischaemia and cortical laminar necrosis. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stephanie Phillipps
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
| | - Frederike Schiborra
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
| | - Aran Nagendran
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
| |
Collapse
|
|
18
|
Criado GG, Paiva ADCM, Britto VSD, Michelini IV, Simões KMP, Motta MMDS. Retinal vascular occlusions after nonocular surgeries. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
|
19
|
Arestov SO, Gerasimova EV, Gushcha AO. [Potential complications of patient positioning in spine surgery]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:112-120. [PMID: 35170284 DOI: 10.17116/neiro202286011112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patient position on the operating table during spine surgery is important for optimal intraoperative manipulations. However, this position is far from physiological one. An unnatural position, surgery time and sometimes necessary intraoperative change in body position can lead to certain neurological and somatic complications. Most of these events can significantly reduce the patient's working capacity and quality of life and even result disability. Medical staff placing the patient on operating table, neurosurgeons and anesthesiologists should be aware of risk factors of similar complications and their prevention. The authors describe the most serious and difficult for correction conditions, such as peripheral neuropathy, damage to visual analyzer, as well as optimal method of patient positioning.
Collapse
|
|
20
|
Young ME, Mears SC, Sallam AB, Sanders RN, Barnes CL, Stambough JB. Corneal Abrasions in Total Joint Arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12:21514593211060101. [PMID: 34868725 PMCID: PMC8641105 DOI: 10.1177/21514593211060101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.
Collapse
Affiliation(s)
- Megan E Young
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Riley N Sanders
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
|
21
|
Khattab MFM, Sykes DAW, Abd-El-Barr MM, Waguia R, Montaser A, Ghamry SE, Elhawary Y. Spine surgery under awake spinal anesthesia: an Egyptian experience during the COVID-19 pandemic. Neurosurg Focus 2021; 51:E6. [PMID: 34852322 DOI: 10.3171/2021.9.focus21456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite tremendous advancements in biomedical science and surgical technique, spine surgeries are still associated with considerable rates of morbidity and mortality, particularly in the elderly. Multiple novel techniques have been employed in recent years to adequately treat spinal diseases while mitigating the perioperative morbidity associated with traditional spinal surgery. Some of these techniques include minimally invasive methods and novel anesthetic and analgesic methods. In recent years, awake spine surgery with spinal anesthesia has gained attention as an alternative to general anesthesia (GA). In this study, the authors retrospectively reviewed a single-institution Egyptian experience with awake spine surgery using spinal anesthesia during the COVID-19 pandemic. METHODS Overall, 149 patients who were admitted to As-Salam International Hospital in Cairo for lumbar and lower thoracic spine surgeries, between 2019 and 2020, were retrospectively reviewed. Patient demographics and comorbidities were collected and analyzed. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were assessed at different time intervals including preoperatively, immediately after surgery, and 1 year postoperatively. Patient satisfaction was queried through a questionnaire assessing patient preference for traditional anesthesia or spinal anesthesia. RESULTS Of the 149 patients who successfully received spine surgery with spinal anesthesia, there were 49 males and 100 females. The cohort age ranged from 22 to 85 years with a mean of 47.5 years. The operative time ranged from 45 to 300 minutes with a mean estimated blood loss (EBL) of 385 ± 156 mL. No major cardiopulmonary or intraoperative complications occurred, and patients were able to eat immediately after surgery. Patients were able to ambulate without an assistive device 6 to 8 hours after surgery. Decompression and fusion patients were discharged on postoperative days 2 and 3, respectively. VAS and ODI scores demonstrated excellent pain relief, which was maintained at the 1-year postoperative follow-up. No 30- or 90-day readmissions were recorded. Of 149 patients, 124 were satisfied with spinal anesthesia and would recommend spinal anesthesia to other patients. The remaining patients were not satisfied with spinal anesthesia but reported being pleased with their postoperative clinical and functional outcomes. One patient was converted to GA due to the duration of the procedure. CONCLUSIONS Patients who received spinal anesthesia for awake spine surgery experienced short stays in the hospital, no readmissions, patient satisfaction, and well-controlled pain. The results of this study have validated the growing body of literature that demonstrates that awake spine surgery with spinal anesthesia is safe and associated with superior outcomes compared with traditional GA. Additionally, the ability to address chronic debilitating conditions, such as spinal conditions, with minimal use of valuable resources, such as ventilators, proved useful during the COVID-19 pandemic and could be a model should other stressors on healthcare systems arise, especially in developing areas of the world.
Collapse
Affiliation(s)
| | - David A W Sykes
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - Romaric Waguia
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Amr Montaser
- 3Aneaesthesia Department, As-Salam International Hospital, Cairo
| | | | | |
Collapse
|
|
22
|
De Cassai A, Geraldini F, Zarantonello F, Sella N, Negro S, Andreatta G, Salvagno M, Boscolo A, Navalesi P, Munari M. A practical guide to patient position and complication management in neurosurgery: a systematic qualitative review. Br J Neurosurg 2021; 36:583-593. [PMID: 34726549 DOI: 10.1080/02688697.2021.1995593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Adequate patient positioning is of paramount importance in neurosurgery. Complications related to the position are common and make up for more than 16% of the claims towards anaesthesiologists and neurosurgeons. This paper aims to provide the anaesthesiologist with a practical guide to avoid common pitfalls related to the patient positioning process. METHOD We performed a systematic review of the medical literature for the identification, screening, and inclusion of articles. The bibliographic search was conducted on June 1st, 2021 by two of the authors. In this review, we included articles indexed by MEDLINE, Cochrane Library, or Google Scholar. RESULTS We retrieved a total of 5706 unique papers from our initial search. However, after the initial screening, 5363 papers were removed is not related to our research leaving a total of 343 papers. We examined the full text of all the 343 articles including 68 of them in the final qualitative analysis. DISCUSSION In this review we examine the most common neurosurgical positions: supine, sitting, lateral, park-bench, prone, jack-knife, and knee-chest. For each of them, the proper positioning and related complications are described. Particular attention is given to the prevention and management of these complications, providing a practical guide for clinicians.
Collapse
Affiliation(s)
- Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | - Federico Geraldini
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | | | - Nicolò Sella
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Sebastiano Negro
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giulio Andreatta
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Michele Salvagno
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| |
Collapse
|
|
23
|
Badessa GG, Almeida JP, Fukushima JT, Badessa M, Colella F, Torres ML, Alves MR, Falcão LFR, Silveira CH, Alfano AMVL, Amaral Neto M, Nakashima AF, Carmona MJC. Incidence and risk factors of postoperative visual function impairment in elderly patients undergoing nonocular surgery: a prospective cohort study. Braz J Anesthesiol 2021; 71:599-606. [PMID: 34606785 PMCID: PMC9373636 DOI: 10.1016/j.bjane.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elderly patients may present with visual function impairment after surgery, which may increase the incidence of postoperative delirium and falls and decrease their quality of life. The aim of this study was to assess visual function in elderly patients after long-duration nonocular surgery to determine the incidence and risk factors for visual function impairment after surgery. METHODS This prospective and observational study included patients aged between 60 and 80 years who had been scheduled for elective nonocular surgery expected to last longer than 120 minutes under general anesthesia. Ocular examinations were performed before surgery, on postoperative day 3 and on postoperative day 21 and consisted of a LogMAR-Snellen chart test, a Jager chart test, biomicroscopy, optical tonometry, ocular motility assessment and fundoscopy. Baseline characteristics of all patients as well as intraoperative and postoperative data were collected. RESULTS A total of 107 patients were included in the final analysis. Visual function impairment was diagnosed in 21 patients (19.6%) at POD 3. Of those, 7 patients (6.5%) still presented with visual changes at POD 21. On POD 3, compared with that at baseline, visual acuity assessed by the Snellen chart test had decreased in these patients. Significant differences regarding refraction tests and intraocular pressure measures were also found. Multivariable analysis identified diabetes mellitus, duration of surgery, hypotension during anesthesia induction, lower peripheral oxygen saturation at the end of the procedure and body mass index as independent risk factors for postoperative visual impairment. CONCLUSION In elderly patients undergoing long-duration nonocular procedures under general anesthesia, the incidence of visual function impairment was considerably high. Most patients recovered to baseline visual function, but clinically significant visual changes may still be present 3 weeks after surgery. Obesity, diabetes mellitus, and the duration of surgical and anesthetic techniques appear to increase the risk of visual impairment after surgery.
Collapse
Affiliation(s)
- Guinther G Badessa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil.
| | - Juliano Pinheiro Almeida
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Julia Tizue Fukushima
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Marianne Badessa
- Hospital São Paulo Escola Paulista de Medicina, Oftalmologia, São Paulo, SP, Brazil
| | - Felipe Colella
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Marcelo L Torres
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Milton Ruiz Alves
- Hospital São Paulo Escola Paulista de Medicina, Oftalmologia, São Paulo, SP, Brazil
| | - Luiz Fernando R Falcão
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Cirilo Haddad Silveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | | | - Mauricio Amaral Neto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| | - Aloísio Fumio Nakashima
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Oftalmologia, São Paulo, SP, Brazil
| | - Maria José C Carmona
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Anestesia e Cuidados Intensivos, São Paulo, SP, Brazil
| |
Collapse
|
|
24
|
Comprehensive perioperative eye protection. Braz J Anesthesiol 2021; 71:595-598. [PMID: 34599969 PMCID: PMC9373210 DOI: 10.1016/j.bjane.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/23/2022] Open
|
|
25
|
Ma HK, Bebawy JF. Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies. J Neurosurg Anesthesiol 2021; 33:293-299. [PMID: 31929351 DOI: 10.1097/ana.0000000000000674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.
Collapse
Affiliation(s)
- Heung Kan Ma
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | |
Collapse
|
|
26
|
Gerber D, Eberle B, Erdoes G. Checking the integrity of eyes in prone position: A novel application of video laryngoscopes. SAGE Open Med Case Rep 2021; 9:2050313X211015885. [PMID: 34094563 PMCID: PMC8141984 DOI: 10.1177/2050313x211015885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Daniel Gerber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
|
27
|
Xiong J, Liang G, Hu L, Chen W, Deng J, Gu J, Li Y, Wang G, Sun Y. Transient visual acuity loss after spine surgery in the prone position: a case report and literature review. J Int Med Res 2021; 48:300060520952279. [PMID: 32883134 PMCID: PMC7479872 DOI: 10.1177/0300060520952279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Visual loss after spine surgery in the prone position is a disastrous postoperative
complication because it is almost irreversible. Additionally, the optimal treatments and
recommended professional guidelines for visual loss after spine surgery are deficient. A
43-year-old man developed visual loss after spine surgery in the prone position. Immediate
ophthalmic consultation confirmed central retinal artery occlusion. Therefore, combined
therapies were administered, including neurotrophy, anticoagulation, vasodilation, and
adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment,
his visual acuity gradually recovered from 5 hours postoperatively and continued to
improve thereafter. We reviewed the literature on postoperative visual loss with a focus
on spine surgery in the prone position. Because the etiology of this complication is
complex and has few effective treatments, the best method for its avoidance is to pay
close attention to preventing it during surgery.
Collapse
Affiliation(s)
- Jun Xiong
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guiling Liang
- Department of Anesthesiology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Liang Hu
- Department of Anesthesiology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Wei Chen
- Department of Anesthesiology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Jie Deng
- Department of Ophthalmology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Jun Gu
- Department of Neurosurgery, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Yushi Li
- Department of Anesthesiology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Guoyi Wang
- Department of Anesthesiology, Korla Hospital, The Second Division of Xinjiang Production and Construction Corps. Jiaotong Xilu, Korla, Bayingol Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region of China, Xinjiang, China
| | - Yongxing Sun
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
28
|
Parizek T, Skulec R, Liehneova I, Prasek P, Cerny V. No significant retinal damage induced by major orthopedic surgery - a pilot study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:217-221. [PMID: 33885047 DOI: 10.5507/bp.2021.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perioperative visual loss is one of the rare but devastating complications of anesthesia and surgery. The incidence of less severe or even subclinical postoperative visual dysfunction is unknown. Therefore, we decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT). METHODS Adult patients indicated for elective knee replacement surgery with the absence of known retinal or optic nerve disease were included. Each patient underwent baseline OCT examination of the eyes one day before surgery and it was repeated 4-7 days after the surgery. The surgery was done under general and epidural anesthesia. RESULTS A total of 18 patients (6 men and 12 women) at the age of 70.8±7.1 years were enrolled. We found statistically significant changes in the Macular central thickness and in a few areas of the Retinal Nerve Fiber Layer between the baseline and postoperative measurements. CONCLUSIONS Even though we found significant changes in some parameters, we did not confirm that general anesthesia and/or surgical damage causes significant damage of the retina using OCT measurement. TRIAL REGISTRATION ClinicalTrials.gov (NCT04311801).
Collapse
Affiliation(s)
- Tomas Parizek
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic.,Emergency Medical Service of the Usti Region, Socialni Pece 799/71, Usti nad Labem 400 11, Czech Republic.,Department of Surgery, Faculty of Medicine, Charles University in Hradec Kralove and University Hospital Hradec Kralove, Simkova 870, Hradec Kralove 500 03, Czech Republic
| | - Roman Skulec
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic.,Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic.,Department of Anesthesiology and Intensive Care, Faculty of Medicine, Charles University in Hradec Kralove and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.,Department of Nursing and Midwifery, Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, Usti nad Labem 400 96, Czech Republic
| | - Ivana Liehneova
- Department of Ophtalmology, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic
| | - Petr Prasek
- Department of Ophtalmology, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic.,Department of Anesthesiology and Intensive Care, Faculty of Medicine, Charles University in Hradec Kralove and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.,Department of Research and Development, Faculty of Medicine, Charles University in Hradec Kralove and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| |
Collapse
|
|
29
|
Zhang B, He LX, Yao YT. Visual loss in patients undergoing cardiac surgery. J Clin Anesth 2021; 71:110229. [PMID: 33721593 DOI: 10.1016/j.jclinane.2021.110229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Bo Zhang
- Department of Anesthesiology, Tianjin Union Medical Center, Tianjin, China
| | - Li-Xian He
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
|
30
|
Complete Vision Loss after Laparoscopic Hysterectomy. Case Rep Obstet Gynecol 2021; 2021:6643703. [PMID: 33728078 PMCID: PMC7937478 DOI: 10.1155/2021/6643703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a 34-year-old gravida 6 para 4 female who experienced POVL following an uncomplicated laparoscopic hysterectomy. Operating time was 174 minutes, and EBL was 75 mL. After surgery, she complained of complete vision loss with no light perception. No cerebral hemorrhage or ischemia was detected on imaging. Funduscopic exam revealed no structural abnormalities. On postoperative day 7, she received an IV methylprednisolone taper. The following morning, she reported mild light perception. Later that night, she reported a partial return of visual acuity and was discharged home. At her 2-week postoperative visit, her vision had returned to baseline. POVL is an emergency and prompt evaluation should be initiated to optimize outcome.
Collapse
|
|
31
|
Singh RB, Khera T, Ly V, Saini C, Cho W, Shergill S, Singh KP, Agarwal A. Ocular complications of perioperative anesthesia: a review. Graefes Arch Clin Exp Ophthalmol 2021; 259:2069-2083. [PMID: 33625566 DOI: 10.1007/s00417-021-05119-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Ocular complications associated with anesthesia in ocular and non-ocular surgeries are rare adverse events which may present with clinical presentations vacillating between easily treatable corneal abrasions to more serious complication such as irreversible bilateral vision loss. In this review, we outline the different techniques of anesthetic delivery in ocular surgeries and highlight the incidence and etiologies of associated injuries. The changes in vision in non-ocular surgeries are mistaken for residual sedation or anesthetics, therefore require high clinical suspicion on part of the treating ophthalmologists, to ensure early diagnosis, adequate and swift management especially in surgeries such as cardiac, spine, head and neck, and some orthopedic procedures, that have a comparatively higher incidence of ocular complications. In this article, we review the literature for reports on the clinical incidence of different ocular complications associated with anesthesia in non-ocular surgeries and outline the current understanding of pathophysiological processes associated with these adverse events.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA.,Department of Ophthalmology, Leiden University Medical Center, ZA, 2333, Leiden, The Netherlands
| | - Tanvi Khera
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, 02215, Boston, USA
| | - Victoria Ly
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Chhavi Saini
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Wonkyung Cho
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Sukhman Shergill
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| |
Collapse
|
|
32
|
Pircher A, Holm S, Huss F. Left orbital compartment syndrome and right anterior ischemic optic neuropathy in a patient with severe burns despite non-aggressive fluid resuscitation. Scars Burn Heal 2021; 7:20595131211006659. [PMID: 33912354 PMCID: PMC8050757 DOI: 10.1177/20595131211006659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ophthalmological complications such as orbital compartment syndrome (OCS) and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. While OCS requires urgent surgical intervention, no current treatment is established to treat, or prevent, ischemic optic neuropathy in patients with burns. METHODS The authors report a case of a 38-year-old woman with flame burns including the periorbital regions who developed OCS on the left side and anterior ischemic optic neuropathy (AION) on the right side despite non-aggressive fluid resuscitation. Immediate lateral canthotomy combined with inferior cantholysis was performed on the left side. DISCUSSION AND CONCLUSION OCS and AION need to be considered as potential complications even in critically ill patients with facial burns who do not receive aggressive fluid resuscitation. Whether an early surgical intervention will lower the risk of AION development is, however, speculative. LAY SUMMARY Ophthalmological complications such as orbital compartment syndrome and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. We present a case of a critically ill patient with severe facial burns who developed orbital compartment syndrome on the left side and anterior ischemic optic neuropathy on the right side even though our patient did not receive aggressive fluid resuscitation.Our case is particular because both of these rare complications are seen in a single patient and neither received aggressive fluid resuscitation. The fact that the patient did not develop ischemic optic neuropathy on the side where the lateral canthotomy was performed (only on the side where the patient had orbital compartment syndrome), this case might raise the discussion of whether an early surgical intervention might lower the risk of ischemic optic neuropathy development in patients with facial burns.
Collapse
Affiliation(s)
- Achmed Pircher
- Department of Neuroscience/Ophthalmology,
Uppsala University, Uppsala, Sweden
| | - Sebastian Holm
- Burn Center, Department of Plastic- and
Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Plastic
Surgery, Uppsala University, Uppsala, Sweden
| | - Fredrik Huss
- Burn Center, Department of Plastic- and
Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Plastic
Surgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
|
33
|
Roth S, Raphael J. Cardiac Surgery and Ischemic Optic Neuropathy. J Cardiothorac Vasc Anesth 2020; 35:39-40. [PMID: 33004268 DOI: 10.1053/j.jvca.2020.08.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Steven Roth
- Anesthesiology, University of Illinois College of Medicine, Chicago, IL
| | - Jacob Raphael
- Divisions of Adult and Pediatric Cardiothoracic Anesthesia, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
|
34
|
Truong-Le M, Mallery RM. Neurovascular Causes of Acute Monocular Visual Loss. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
35
|
Vandiver MS, Vacas S. Interventions to improve perioperative neurologic outcomes. Curr Opin Anaesthesiol 2020; 33:661-667. [PMID: 32769748 DOI: 10.1097/aco.0000000000000905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients. RECENT FINDINGS There are several strategies the anesthesiologist can undertake to prevent or treat conditions, such as perioperative neurocognitive disorders, spinal cord ischemia, perioperative stroke, and postoperative visual loss. SUMMARY A thorough understanding of threats to patients' neurologic well-being is essential to excellent clinical practice.
Collapse
Affiliation(s)
- Matthew S Vandiver
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | |
Collapse
|
|
36
|
Bond JD, Zhang M. Clinical Anatomy of the Extradural Neural Axis Compartment: A Literature Review. World Neurosurg 2020; 142:425-433. [PMID: 32711147 PMCID: PMC7375305 DOI: 10.1016/j.wneu.2020.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The extradural neural axis compartment (EDNAC) is an adipovenous zone located between the meningeal and endosteal layers of the dura and has been minimally investigated. It runs along the neuraxis from the orbits down to the coccyx and contains fat, valveless veins, arteries, and nerves. In the present review, we have outlined the current knowledge regarding the structural and functional significance of the EDNAC. METHODS We performed a narrative review of the reported EDNAC data. RESULTS The EDNAC can be organized into 4 regional enlargements along its length: the orbital, lateral sellar, clival, and spinal segments, with a lateral sellar orbital junction linking the orbital and lateral sellar segments. The orbital EDNAC facilitates the movement of the eyeball and elsewhere allows limited motility for the meningeal dura. The major nerves and vessels are cushioned and supported by the EDNAC. Increased intra-abdominal pressure will also be conveyed along the spinal EDNAC, causing increased venous pressure in the spine and cranium. From a pathological perspective, the EDNAC functions as a low-resistance, extradural passageway that might facilitate tumor encroachment and expansion. CONCLUSIONS Clinicians should be aware of the extent and significance of the EDNAC, which could affect skull base and spine surgery, and have an understanding of the tumor spread pathways and growth patterns. Comparatively little research has focused on the EDNAC since its initial description. Therefore, future investigations are required to provide more information on this underappreciated component of neuraxial anatomy.
Collapse
Affiliation(s)
- Jacob D Bond
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Dundin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, Anhui Medical University, Hefei, China.
| |
Collapse
|
|
37
|
Assawakawintip C, Nuttall GA, Garrity JA, Smith MM, Dearani JA. Incidence of Ischemic Optic Neuropathy After Cardiopulmonary Bypass: 20-Year Experience. J Cardiothorac Vasc Anesth 2020; 35:35-38. [PMID: 32843271 DOI: 10.1053/j.jvca.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study evaluated the incidence and risk factors for ischemic optic neuropathy (ION) as a complication of cardiac surgery requiring cardiopulmonary bypass (CPB). DESIGN Retrospective chart review of prospectively collected data at a tertiary care center. SETTING Single tertiary academic referral center. PARTICIPANTS This study comprised 44,568 cardiac surgery patients who underwent CPB between January 1, 1995, and January 5, 2017, using the Society of Thoracic Surgeons database and cross-matching it with International Classification of Diseases codes for visual changes. INTERVENTIONS None; this was a retrospective chart review. MEASUREMENTS AND MAIN RESULTS Six patients initially were identified as experiencing visual changes. Only 1 patient from 44,568 cardiac surgeries with CPB between January 1, 1995, and January 5, 2017, experienced ION, for an incidence 0.22 per 10,000. Because only 1 patient experienced ION, the authors were unable to determine risk factors for this complication; however, the nadir perioperative hemoglobin in the affected patient was 7.3 g/dL (postoperative). CONCLUSION The incidence of ION decreased from 6 per 10,000 in the authors' previous study from 1976-1994 to 0.22 per 10,000 in the present study. Because of the low incidence of this dreaded complication, the authors were not able to identify risk factors for ION. Practice improvements (eg, transition to membrane oxygenators, blood transfusion guidelines, less- invasive surgical options for high-risk patients) during the time between the authors' studies likely affected the incidence reduction.
Collapse
Affiliation(s)
- Chalailak Assawakawintip
- Mayo Clinic College of Medicine, Rochester, MN; Department of Anesthesiology, Wetchakarunrasm Hospital, Bangkok, Thailand
| | - Gregory A Nuttall
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - James A Garrity
- Department of Ophthmology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN
| |
Collapse
|
|
38
|
Meekins JM, McMurphy RM, Roush JK. The effect of body position on intraocular pressure in anesthetized horses. Vet Ophthalmol 2020; 23:668-673. [PMID: 32379387 DOI: 10.1111/vop.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of four recumbent body positions on intraocular pressure (IOP) in anesthetized normal horses. ANIMALS STUDIED Ten nonglaucomatous adult horses. PROCEDURES Intraocular pressure was measured with a rebound tonometer in both eyes of standing sedated horses (baseline), then under general anesthesia during four randomized recumbent body positions, including Trendelenburg (Tr; 15-degree head down), reverse Trendelenburg (RTr; 15-degree head up), dorsal, and lateral; only the superior eye was measured in lateral positions. The mean of 3 IOP readings was taken at each position, allowing a minimum of 2 minutes of acclimatization after each position change before obtaining measurements. Repeated Measures Analysis with Newman-Keuls Multiple Comparison Post hoc was used to compare IOPs in different positions, and linear regression was used to compare IOP with age and weight cofactors. RESULTS When compared to baseline, the greatest change in IOP occurred in Tr (increase of 25.63 ± 8.12 mm Hg). When comparing all recumbent positions to baseline, IOP significantly increased in 3 of 4 body positions (P < .001), with no significant difference identified between RTr and baseline. When comparing all body positions to each other, the greatest IOP difference occurred between the Tr and the RTr positions (increase of 26.95 ± 5.41 mm Hg). Age and weight were not correlated with IOP in any position. CONCLUSIONS Recumbent body position significantly increases IOP in normal eyes of horses under injectable anesthesia.
Collapse
Affiliation(s)
- Jessica M Meekins
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - Rose M McMurphy
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - James K Roush
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| |
Collapse
|
|
39
|
VAN Wicklin SA. Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery. Int J Spine Surg 2020; 14:195-208. [PMID: 32355626 PMCID: PMC7188102 DOI: 10.14444/7029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients undergoing surgery in the prone position may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients. The research question to be addressed is "What is the magnitude of the increase in intraocular pressure at specific perioperative time points in adults undergoing surgery in the prone position?" METHODS Comprehensive search strategies were used to identify nine eligible studies (N = 229). Standardized mean difference effect sizes were calculated for two intraoperative time points.Time points for meta-analysis were selected to achieve the greatest number of comparisons for analysis at each time point. Prediction intervals for each time point were also calculated to show the dispersion of true effect sizes around the mean. RESULTS Meta-analysis showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position (T1: standardized mean difference [d] = 2.55; P < .001) and continued to increase significantly until the end of the prone position (T2: d = 3.44; P = .002). CONCLUSIONS Intraocular pressure increases of this magnitude demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the prone position. CLINICAL RELEVANCE Implementing preoperative ophthalmologic examinations for patients undergoing surgery in the prone position may help to reduce the risk for ocular injury. Intraoperative interventions that can be implemented to reduce or mitigate the increase in intraocular pressure include implementing a 5- to 10-degree reverse Trendelenburg prone position, reducing the amount of time the patient is in the prone position, considering staged procedures, monitoring intraocular pressure, providing periodic position changes or rest periods, preventing pressure on the eye, and administering specific medications or anesthetics.
Collapse
|
|
40
|
Chang CY, Chien YJ, Wu MY. Attenuation of increased intraocular pressure with propofol anesthesia: A systematic review with meta-analysis and trial sequential analysis. J Adv Res 2020; 24:223-238. [PMID: 32373356 PMCID: PMC7191318 DOI: 10.1016/j.jare.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022] Open
Abstract
Attenuation of an increase in intraocular pressure (IOP) is crucial to preventing devastating postoperative visual loss following surgery. IOP is affected by several factors, including the physiologic alteration due to pneumoperitoneum and patient positioning and differences in anesthetic regimens. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on IOP. We searched multiple databases for relevant studies published before October 2019. Randomized controlled trials comparing the effects of propofol-based TIVA and volatile anesthesia on IOP during surgery were considered eligible for inclusion. Twenty studies comprising 980 patients were included. The mean IOP was significantly lower in the propofol-based TIVA group after intubation, pneumoperitoneum, Trendelenburg positioning, and lateral decubitus positioning. Moreover, mean arterial pressure and peak inspiratory pressure were also lower after intubation in the propofol-based TIVA group. Trial sequential analyses for these outcomes were conclusive. Propofol-based TIVA is more effective than volatile anesthesia during surgery at attenuating the elevation of IOP and should be considered, especially in at-risk patients.
Collapse
Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| |
Collapse
|
|
41
|
Abstract
PURPOSE To report the first two observations of bilateral paracentral acute middle maculopathy in the early postoperative period after cardiopulmonary bypass procedures. METHODS Comprehensive ophthalmic examinations were performed, including best-corrected visual acuity, Humphrey visual field testing, dilated fundus examination, and optical coherence tomography. RESULTS Two patients complained of unilateral vision loss after cardiac surgery involving cardiopulmonary bypass. Unilateral optic disc edema consistent with ischemic optic neuropathy was observed in the symptomatic eye of each patient, whereas scattered cotton-wool spots were identified bilaterally. In addition, optical coherence tomography imaging revealed bilateral paracentral acute middle maculopathy, correlating with visual field defects detected on automated perimetry in the asymptomatic eyes. CONCLUSION Although symptomatic postoperative vision loss is a rare complication of cardiac surgery, intraoperative retinal microvascular nonperfusion as a consequence of extracorporeal circulation of blood may be a more common and under-recognized occurrence.
Collapse
|
|
42
|
Ziegler AM, Spencer DA, Nockels RP, Leonetti JP, Ibrahim TF. Tarik Syndrome: Reversible Postoperative Blindness Secondary to Occipital Seizures. World Neurosurg 2019; 131:58-61. [PMID: 31376555 DOI: 10.1016/j.wneu.2019.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postoperative blindness is a devastating surgical complication. Although usually associated with prolonged cardiac and prone spinal operations, it may follow other procedures as well. Postoperative blindness is most commonly caused by a vascular etiology, but it can more rarely be caused by status epilepticus. We have previously reported a case of this phenomenon following a staged spinal deformity surgery. CASE DESCRIPTION Here we report 2 additional cases following a skull base procedure and a single stage lumbar spine surgery. In all instances, rapid recognition that the patients' blindness was due to occipital seizures resulted in acute antiepileptiform treatment and full restoration of vision. CONCLUSIONS Although a rare phenomenon, this syndrome, first recognized and described by Tarik F. Ibrahim, should be considered in any patient with postoperative visual impairment.
Collapse
Affiliation(s)
- Andrea M Ziegler
- Departments of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA.
| | - Drew A Spencer
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Russ P Nockels
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John P Leonetti
- Departments of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Tarik F Ibrahim
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA
| |
Collapse
|
|
43
|
Ischemic Optic Neuropathy Following Spine Surgery: Case Control Analysis and Systematic Review of the Literature. Spine (Phila Pa 1976) 2019; 44:1087-1096. [PMID: 30817727 DOI: 10.1097/brs.0000000000003010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case-control analysis and systematic literature review. OBJECTIVE To illustrate the prognosis and perioperative risk factors associated with this condition. SUMMARY OF BACKGROUND DATA Ischemic optic neuropathy (ION) is the most common pathological diagnosis underlying postoperative vision loss. It comes in two primary forms-anterior (AION)-affecting the optic disc or posterior (PION) affecting the optic nerve proximal to the disc. Spine surgery remains one of the largest sources of acute perioperative visual loss. METHODS We performed a 1:4 case-control analysis (by age and year of surgery) for patients with ION and those who didn't develop ION following spine surgery at our institution. A systematic literature search of Medline, Embase, Scopus from inception to September 2017 as also performed. RESULTS We identified 12 cases from our institution. Comparison to 48 matched controls revealed fusion, higher number of operative levels, blood loss, and change in hemoglobin, hematocrit to be significantly associated with ION. Majority were diagnosed with PION (83%, 10/12) and had bilateral presentation (75%, 9/12). Only 30% patients (3/10) demonstrated improvement in visual acuity while the rest remained either unchanged (40%, 4/10) or worsened (20%, 2/10) at last follow-up. Literature review identified 182 cases from 42 studies. Posterior ischemic optic neuropathy (PION) was found in 58.7% (114/194) of cases, anterior ischemic optic neuropathy (AION) in 17% (33/19) and unspecified ION in 24% (47/194). PION was associated with higher odds of severe visual deficit at immediate presentation (odds ratio [OR]: 6.45, confidence interval [CI]: 1.04-54.3, P = 0.04) and last follow-up. CONCLUSION PION is the most common cause of vision loss following spine surgery and causes more severe visual deficits compared with AION. Prone spine surgery especially multi-level fusions with longer operative time, higher blood loss, and intraoperative hypotension are most associated with the development of this devastating complication. LEVEL OF EVIDENCE 3.
Collapse
|
|
44
|
Neurological Complications in Cardiac Surgery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
|
45
|
Czorlich P, Krätzig T, Kluge N, Skevas C, Knospe V, Spitzer MS, Dreimann M, Mende KC, Westphal M, Eicker SO. Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid. J Neurosurg 2019; 131:271-280. [PMID: 30141760 DOI: 10.3171/2018.3.jns173098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perioperative visual loss (POVL) is a rare but serious complication in surgical disciplines, especially in spine surgery. The exact pathophysiology of POVL remains unclear, but elevated intraocular pressure (IOP) is known to be part of it. As POVL is rarely described in patients undergoing intracranial or intradural surgery, the aim of this study was to investigate the course of IOP during neurosurgical procedures with opening of the dura mater and loss of CSF. METHODS In this prospective, controlled trial, 64 patients fell into one of 4 groups of 16 patients each. Group A included patients undergoing spine surgery in the prone position, group B patients had intracranial procedures in the prone position, and group C patients were treated for intracranial pathologies in a modified lateral position with the head rotated. In groups A-C, the dura was opened during surgery. Group D patients underwent spine surgeries in the prone position with an intact dura. IOP was measured continuously pre-, peri-, and postoperatively. RESULTS In all groups, IOP decreased after induction of anesthesia and increased time dependently after final positioning for the operation. The maximum IOP in group A prior to opening of the dura was 28.6 ± 6.2 mm Hg and decreased to 23.44 ± 4.9 mm Hg directly after dura opening (p < 0.0007). This effect lasted for 30 minutes (23.5 ± 5.6 mm Hg, p = 0.0028); after 60 minutes IOP slowly increased again (24.5 ± 6.3 mm Hg, p = 0.15). In group B, the last measured IOP before CSF loss was 28.1 ± 5.0 mm Hg and decreased to 23.5 ± 6.1 mm Hg (p = 0.0039) after dura opening. A significant IOP decrease in group B lasted at 30 minutes (23.6 ± 6.0 mm Hg, p = 0.0039) and 60 minutes (23.7 ± 6.0 mm Hg, p = 0.0189). In group C, only the lower eye showed a decrease in IOP up to 60 minutes after loss of CSF (opening of dura, p = 0.0007; 30 minutes, p = 0.0477; 60 minutes, p = 0.0243). In group D (control group), IOP remained stable throughout the operation after the patient was prone. CONCLUSIONS This study is the first to demonstrate that opening of the dura with loss of CSF during neurosurgical procedures results in a decrease in IOP. This might explain why POVL predominantly occurs in spinal but rarely in intracranial procedures, offers new insight to the pathophysiology of POVL, and provides the basis for further research and treatment of POVL.German Clinical Trials Register (DRKS) no.: DRKS00007590 (drks.de).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marc Dreimann
- 3Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | |
Collapse
|
|
46
|
Ferreira JTFDC. OPHTHALMOLOGIC COMPLICATIONS IN SPINAL SURGERIES: LITERATURE REVIEW. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191802186474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Literature review using PubMed, relating ophthalmologic complications in spinal surgery. Ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO) and cortical blindness (CB) constitute the majority of cases. These are rare complications and have a poor prognosis. Post-operative visual loss (POVL) occurs most often in surgical procedures performed in the prone position. Being male, anemia, blood transfusion, and prolonged surgery time are related to ION, while malposition and direct compression of the eyeball are related to the development of CRAO. Level of Evidence III; Systematic reviewbof level III studies.
Collapse
|
|
47
|
Roth S, Dreixler J, Newman NJ. Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy. Eur J Anaesthesiol 2019; 35:840-847. [PMID: 29771733 DOI: 10.1097/eja.0000000000000829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies.
Collapse
Affiliation(s)
- Steven Roth
- From the Department of Anesthesiology (SR), Department of Ophthalmology and Visual Sciences, University of Illinois (SR), Anesthesia and Critical Care, University of Chicago, Chicago, Illinois (JD), Department of Ophthalmology and Neurology (NJN) and Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA (NJN)
| | | | | |
Collapse
|
|
48
|
Hofer RE, Evans KD, Warner MA. Ocular injury during spine surgery. Can J Anaesth 2019; 66:772-780. [PMID: 30790199 DOI: 10.1007/s12630-019-01323-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/07/2018] [Accepted: 01/01/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Ocular injury and vision loss are rare complications of surgery. Spine surgery has been identified as particularly high risk for postoperative vision loss; nevertheless, ocular injuries have not been comprehensively assessed in this patient population. METHODS This historical cohort study assessed incidence, cause, and risk factors of perioperative ocular injury after spine surgery at a tertiary care medical centre from January 1, 2006 through January 31, 2018. Patients were included who had ocular injury identified during an ophthalmology consultation in the first seven postoperative days. Differences in demographic, laboratory, intraoperative, and postoperative characteristics between those experiencing or not experiencing ocular injury were assessed with Fisher exact and Wilcoxon signed-rank tests for categorical and continuous variables, respectively. RESULTS Of 20,128 qualifying spine surgeries, 39 cases of perioperative ocular injuries were identified (39/20,128; 0.19% [95% confidence interval (CI), 0.14 to 0.26]). The most common ocular injury was blurry vision of unknown cause (13/39; 33%; 95% CI, 18.6 to 46.4), followed by ischemic optic neuropathy (9/39; 23%; 95% CI, 12.6 to 38.3) and corneal abrasion (7/39; 18%; 95% CI, 9.0 to 32.7). All cases of blurry vision of unknown cause were diagnosed via ophthalmology consultation and resolved within several days. Patients with perioperative ocular injury were more likely to have baseline anemia, have undergone fusion and instrumentation procedures, and had longer operative times with greater crystalloid, colloid, and transfusion requirements and more blood loss. CONCLUSIONS Although not representing a causal relationship, these data suggest that surgical factors may have a greater role than demographic characteristics or other clinical factors in the development of perioperative ocular injury. Surgeons, anesthesiologists, and patients should be aware of the increased risk of ocular injury that accompanies longer, more extensive spine operations.
Collapse
Affiliation(s)
- Ryan E Hofer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Kimberly D Evans
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| |
Collapse
|
|
49
|
Intraocular pressure change during laparoscopic sacral colpopexy in patients with normal tension glaucoma. Int Urogynecol J 2019; 30:1933-1938. [PMID: 30643979 DOI: 10.1007/s00192-018-03866-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The steep Trendelenburg position, high pneumoperitoneum pressure, and longer surgical time may lead to significantly increased intraocular pressure (IOP), which could result in unexpected eye disease complications, including perioperative visual loss (POVL). We monitored IOP to induce early laparoscopic sacral colpopexy (LSC) safely. METHODS This prospective study enrolled 39 patients with pelvic organ prolapse (POP), including 10 with eye diseases (6 with normal tension glaucoma and 4 with a narrow anterior chamber and normal range IOP). Enrolled patients underwent LSC under the same surgical settings involving a pneumoperitoneum of 10 mmHg and a Trendelenburg position of 15°. We measured IOP at seven time points during surgery and estimated IOP changes with time in patients with or without eye diseases. RESULTS All patients, with or without eye diseases, experienced significantly elevated IOP during LSC. There were no significant differences between these groups. The average maximal IOP reached 20 mmHg at the end of surgery, and recovered to baseline values with the patient in the supine position at the end of anesthesia. No patient had an IOP of >40 mmHg as a critical threshold during surgery, and no substantial clinical eye symptoms were seen after LSC. CONCLUSIONS Laparoscopic sacral colpopexy using an pneumoperitoneum of 10 mmHg and a Trendelenburg position of 15° during a 3-h surgical period could be performed within a safe range of IOP.
Collapse
|
|
50
|
Ramprasath DR, Thirunarayanan V, Rajan A. LumbarIschemic Optic NeuropathyComplicating Spine Surgery-A Case Report. J Orthop Case Rep 2019; 9:58-62. [PMID: 32405490 PMCID: PMC7210908 DOI: 10.13107/jocr.2019.v09.i04.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Post-operative vision loss (POVL),i.e., blindness is an uncommon complication of any major surgery. In orthopedics, it is encountered mostly in spine surgery. POVL may be due to various pathologies such asischemic optic neuropathy (ION) and central retinal artery occlusion. A rise in intraocular pressure is one of the contributing factors. ION associated with lumbar spine surgery has been designated as lumbar ION. Even though its incidence is as low as 0.02%, once occurs, the consequence is disastrous. Our case of POVL due to posterior ION has certain distinct features which differentiate it from the routine cases reported in literature. Case Report Our case is a 33-year-old gentleman who underwent revision lumbar spine surgery, for L3-L4 disc protrusion (recurrence) and L4-L5 disc protrusion with bilateral foot drop, in the form of posterior decompression, pedicle screw fixation from L3 to L5, and two-level transforaminal lumbar interbody fusion using cages. The patient developed POVL involving one eye which was diagnosed on operating table itself (immediately after extubation). Immediate appropriate treatment was initiated with the cooperation of ophthalmologist. The patient subsequently recovered, from no perception of light, to a visual acuity of 6/24, and is doing well regarding vision as well as neurology. Conclusion Since POVL is an avoidable complication, knowledge regarding POVL and its contributing factors can lead to the prevention of the development of this complication. Moreover, since POVL has poor prognosis for recovery, prevention is the key. Since POVL can occur after any major surgery (apart from orthopedics), its knowledge can help surgeons in other specialties also.
Collapse
Affiliation(s)
- Dhurvas Ramlal Ramprasath
- Department of Orthopaedics, Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
| | - Vasudevan Thirunarayanan
- Department of Orthopaedics, Government Medical College, Omandurar Estate, Chennai, Tamil Nadu, India
| | - Arjun Rajan
- Department of Orthopaedics, Apollo Speciality Hospitals, Chennai, Tamil Nadu, India
| |
Collapse
|