The American society of anesthesiologists postoperative visual loss registry: Analysis of 93 spine surgery cases with postoperative visual loss

被引:215
|
作者
Lee, Lorri A.
Roth, Steven
Posner, Karen L.
Cheney, Frederick W.
Caplan, Robert A.
Newman, Nancy J.
Domino, Karen B.
机构
[1] Univ Washington, Harborview Med Ctr, Dept Anesthesiol, Seattle, WA 98104 USA
[2] Univ Washington, Dept Neurol Surg, Seattle, WA 98195 USA
[3] Univ Washington, Dept Anthropol, Seattle, WA 98195 USA
[4] Univ Chicago, Dept Anesthesia & Crit Care, Chicago, IL 60637 USA
[5] Virginia Mason Med Ctr, Seattle, WA 98101 USA
[6] Emory Univ, Dept Ophthalmol, Atlanta, GA 30322 USA
[7] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA 30322 USA
[8] Emory Univ, Dept Neurol Surg, Atlanta, GA 30322 USA
关键词
D O I
10.1097/00000542-200610000-00007
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Postoperative visual loss after prone spine surgery is increasingly reported in association with ischemic optic neuropathy, but its etiology is unknown. Methods: To describe the clinical characteristics of these patients, the authors analyzed a retrospectively collected series of 93 spine surgery cases voluntarily submitted to the American Society of Anesthesiologists Postoperative Visual Loss Registry on standardized data forms. Results: Ischemic optic neuropathy was associated with 83 of 93 spine surgery cases. The mean age of die patients was 50 +/- 14 yr, and most patients were relatively healthy. Mayfield pins supported die head in 16 of 83 cases. The mean anesthetic duration was 9.8 +/- 3.1 h, and the median estimated blood loss was 2.01 (range, 0.1-25 l). Bilateral disease was present M 55 patients, with complete visual loss m die affected eye(s) in 47. ischemic optic neuropathy cases had significantly higher anesthetic duration, blood loss, percentage of patients in Mayfield pins, and percentage of patients with bilateral disease compared with the remaining 10 cases of visual loss diagnosed with central retinal artery occlusion (P < 0.05), suggesting they are of different etiology. Conclusions: Ischemic optic neuropathy was die most common cause of visual loss after spine surgery in the Registry, and most patients were relatively healthy. Blood loss of 1,000 ml or greater or anesthetic duration of 6 h or longer was present in 96% of these cases. For patients undergoing lengthy spine surgery in the prone position, die risk of visual loss should be considered in the preoperative discussion with patients.
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收藏
页码:652 / 659
页数:8
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