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Perioperative visual loss.

Koffi M Kla1, Lorri A Lee2

  • 1Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA.

Best Practice & Research. Clinical Anaesthesiology
|April 3, 2016
PubMed
Summary
This summary is machine-generated.

Perioperative visual loss, often ischemic optic neuropathy, is a rare but severe spine surgery complication. Key risks include male sex, obesity, Wilson frame use, long operations, blood loss, and fluid ratios.

Keywords:
American Society of Anesthesiologists Postoperative Visual Loss Registryanesthesiaischemic optic neuropathyperioperative visual lossspinal fusion

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Area of Science:

  • Neurology
  • Ophthalmology
  • Surgical Complications

Background:

  • Perioperative visual loss (PVL) is a rare yet devastating complication following spine surgery.
  • Ischemic optic neuropathy (ION) is the most common cause of PVL after spinal procedures.
  • PVL is thought to be associated with prolonged elevation of intracranial venous pressure.

Purpose of the Study:

  • To identify significant risk factors for perioperative visual loss (PVL) in spine surgery.
  • To inform preventative strategies and patient counseling regarding PVL.
  • To highlight the importance of managing intraoperative conditions to minimize PVL risk.

Main Methods:

  • A large-scale case-control study was conducted to analyze risk factors for ION following spine surgery.
  • Statistical analysis identified independent predictors of this complication.
  • Literature review and expert opinion were considered in developing practice advisories.

Main Results:

  • Six independent risk factors for ION in spine surgery patients were identified: male sex, obesity, Wilson frame use, extended operative duration, substantial blood loss, and a low colloid-to-crystalloid fluid administration ratio.
  • These factors highlight modifiable and non-modifiable risks associated with the procedure.

Conclusions:

  • Preventing perioperative visual loss in spine surgery requires careful management of identified risk factors.
  • Given the unpredictable nature and severity of PVL, informed consent discussing this risk is crucial for high-risk patients.
  • The American Society of Anesthesiologists has issued practice advisories to guide prevention efforts.