A Study to Evaluate Ocular Changes in Patients Undergoing Spine Surgery in the Prone Position

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2022 Mar 28

PMID 35340948

Authors

Kiranpreet Kaur

Neetu Khanduri

Sumit Sachdeva

Roop Singh

Mamta Bhardwaj

Manju Bala

Affiliations

Soon will be listed here.

Abstract

Background And Aims: AA present prospective study was conducted to evaluate ocular changes occurring in patients undergoing spine surgery in the prone position.

Material And Methods: A total of 44 patients of either sex, belonging to American society of Anaesthesiology I and II (aged 18-60 years) scheduled for elective spine surgery in prone position were enrolled in the study. Baseline IOP and MAP measurement were taken prior to induction. After induction of anaesthesia patients were intubated using flexo-metallic tube of appropriate size. IOP and MAP were recorded after induction of anaesthesia, following completion of surgery and immediately after turning the patient supine and 30 min following extubation. Blood loss and duration of surgery was also noted. The OPP was derived using the formula (OPP = MAP-IOP). Ophthalmic examination was also performed using direct and indirect ophthalmoscopy on the day prior to surgery and on first post-operative day to rule out anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), and retinal ischemia.

Results: Mean IOP significantly increased (18.91 ± 3.56 mm Hg) ( < 0.001) at the end of surgery as compared to baseline value 12.85 ± 3.07 mm Hg. As a result mean OPP significantly reduced (75.12 ± 16.45) ( = 0.0018) at the end of the procedure.

Conclusion: In patient's undergoing spine surgery in the prone position, careful patient positioning with no extrinsic pressure on the eyes, minimal surgical time and blood loss, and prevention of intraoperative hypotension, should be ensured to prevent the IOP rise and a reduction in OPP which can further prevent post-operative visual disturbance.

Citing Articles

Postoperative Glaucoma Decompensation Following Spine Surgery: The Importance of Proper Patient Positioning.

Cherubin T, Jeff N, Goert M, Guelord M, Maoneo I, Mukuetala P Cureus. 2024; 16(11):e73603.

PMID: 39677067 PMC: 11640955. DOI: 10.7759/cureus.73603.

[Small tidal volume hyperventilation relieves intraocular and intracranial pressure elevation in prone spinal surgery: a randomized controlled trial].

Duan X, Wei J, Liang A, Ji X Nan Fang Yi Ke Da Xue Xue Bao. 2024; 44(4):660-665.

PMID: 38708498 PMC: 11073951. DOI: 10.12122/j.issn.1673-4254.2024.04.06.

Perioperative Blindness in Spine Surgery: A Scoping Literature Review.

Sperber J, Owolo E, Zachem T, Bishop B, Johnson E, Lad E J Clin Med. 2024; 13(4).

PMID: 38398364 PMC: 10889585. DOI: 10.3390/jcm13041051.

References

Deniz M, Erakgun A, Sertoz N, Yilmaz S, Ates H, Erhan E . The effect of head rotation on intraocular pressure in prone position: a randomized trial. Braz J Anesthesiol. 2014; 63(2):209-12. DOI: 10.1016/j.bjane.2012.03.008. View

Hunt K, Bajekal R, Calder I, Meacher R, Eliahoo J, Acheson J . Changes in intraocular pressure in anesthetized prone patients. J Neurosurg Anesthesiol. 2004; 16(4):287-90. DOI: 10.1097/00008506-200410000-00005. View

Roth S, Tung A, Ksiazek S . Visual loss in a prone-positioned spine surgery patient with the head on a foam headrest and goggles covering the eyes: an old complication with a new mechanism. Anesth Analg. 2007; 104(5):1185-7, tables of contents. DOI: 10.1213/01.ane.0000264319.57758.55. View

Ho V, Newman N, Song S, Ksiazek S, Roth S . Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005; 17(1):38-44. PMC: 2699455. View

Nickels T, Manlapaz M, Farag E . Perioperative visual loss after spine surgery. World J Orthop. 2014; 5(2):100-6. PMC: 4017302. DOI: 10.5312/wjo.v5.i2.100. View

Lee L, Roth S, Posner K, Cheney F, Caplan R, Newman N . The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006; 105(4):652-9. DOI: 10.1097/00000542-200610000-00007. View

Cheng M, Sigurdson W, Tempelhoff R, Lauryssen C . Visual loss after spine surgery: a survey. Neurosurgery. 2000; 46(3):625-30; discussion 630-1. DOI: 10.1097/00006123-200003000-00020. View

Edgcombe H, Carter K, Yarrow S . Anaesthesia in the prone position. Br J Anaesth. 2008; 100(2):165-83. DOI: 10.1093/bja/aem380. View

Katzman S, Moschonas C, Dzioba R . Amaurosis secondary to massive blood loss after lumbar spine surgery. Spine (Phila Pa 1976). 1994; 19(4):468-9. DOI: 10.1097/00007632-199402001-00018. View

10.

Liu T, Bi H, Wang X, Wang G, Li H, Wu H . Change of retinal nerve fiber layer thickness in patients with nonarteritic inflammatory anterior ischemic optic neuropathy. Neural Regen Res. 2014; 7(35):2778-83. PMC: 4190859. DOI: 10.3969/j.issn.1673-5374.2012.35.005. View

11.

SLOCUM H, ONEAL K, Allen C . Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet. 1948; 86(6):729-34. View

12.

Chang S, Miller N . The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital Experience. Spine (Phila Pa 1976). 2005; 30(11):1299-302. DOI: 10.1097/01.brs.0000163884.11476.25. View

13.

Emery S, Daffner S, France J, Ellison M, Grose B, Hobbs G . Effect of Head Position on Intraocular Pressure During Lumbar Spine Fusion: A Randomized, Prospective Study. J Bone Joint Surg Am. 2015; 97(22):1817-23. DOI: 10.2106/JBJS.O.00091. View

14.

Anand S, Mushin A . Cavernous sinus thrombosis following prone position anaesthesia. Eye (Lond). 2004; 19(7):803-4. DOI: 10.1038/sj.eye.6701635. View

15.

Gencer B, Cosar M, Tufan H, Kara S, Arikan S, Akman T . [Changes in retinal nerve fiber layer thickness after spinal surgery in the prone position: a prospective study]. Rev Bras Anestesiol. 2014; 65(1):41-6. DOI: 10.1016/j.bjan.2014.03.005. View

16.

Myers M, Hamilton S, Bogosian A, Smith C, Wagner T . Visual loss as a complication of spine surgery. A review of 37 cases. Spine (Phila Pa 1976). 1997; 22(12):1325-9. DOI: 10.1097/00007632-199706150-00009. View

17.

Walick K, Kragh Jr J, Ward J, Crawford J . Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss. Spine (Phila Pa 1976). 2007; 32(23):2591-5. DOI: 10.1097/BRS.0b013e318158cc23. View

18.

Yang J, Park S, Ji Y, Kim J, Yoo C, Heo H . Postural effects on intraocular pressure and ocular perfusion pressure in patients with non-arteritic anterior ischemic optic neuropathy. BMC Ophthalmol. 2017; 17(1):47. PMC: 5397825. DOI: 10.1186/s12886-017-0441-3. View

19.

DePasse J, Palumbo M, Haque M, Eberson C, Daniels A . Complications associated with prone positioning in elective spinal surgery. World J Orthop. 2015; 6(3):351-9. PMC: 4390897. DOI: 10.5312/wjo.v6.i3.351. View

20.

Kwee M, Ho Y, Rozen W . The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg. 2015; 100(2):292-303. PMC: 4337445. DOI: 10.9738/INTSURG-D-13-00256.1. View