Perioperative visual loss after spine surgery

Table 1 American Society of Anesthesiologists perioperative visual loss practice advisory consensus conclusions

There is a subset of patients who undergo spine procedures while they are positioned prone and receiving general anesthesia that has an increased risk for the development of POVL. This “high-risk” subset includes patients who are anticipated preoperatively to undergo procedures that are prolonged, have substantial blood loss, or both

Consider continuous blood pressure and central venous pressure monitoring in high-risk patients

Consider informing high-risk patients that there is a small, unpredictable risk of POVL

The use of deliberate hypotensive techniques during spine surgery has not been shown to be associated with the development of POVL

Colloids should be used along with crystalloids to maintain intravascular volume in patients who have substantial blood loss

At this time, there is no apparent transfusion threshold that would eliminate the risk of POVL related to anemia

High-risk patients should be positioned so that their heads are level with or higher than the heart, when possible. In addition, their heads should be maintained in a neutral forward position (without significant neck flexion, extension, lateral flexion, or rotation) when possible

Consideration should be given to the use of staged spine procedures in high-risk patients

POVL: Perioperative visual loss.