Dispositivos modernos para reducir la ceguera después de cirugía de columna

Dispositivos modernos para reducir la ceguera después de cirugía de columna


Current intraoperative devices to reduce visual loss after spine surgery.
Uribe AA, Baig MN, Puente EG, Viloria A, Mendel E, Bergese SD.
Departments of Anesthesiology and.
Neurosurg Focus. 2012 Aug;33(2):E14.
Abstract
Postoperative visual loss (POVL) after spine surgery performed with the patient prone is a rare but devastating postoperative complication. The incidence and the mechanisms of visual loss after surgery are difficult to determine. The 4 recognized causes of POVL are ischemic optic neuropathy (approximately 89%), central retinal artery occlusion (approximately 11%), cortical infarction, and external ocular injury. There are very limited guidelines or protocols on the perioperative practice for "prone-position" surgeries. However, new devices have been designed to prevent mechanical ocular compression during prone-position spine surgeries. The authors used PubMed to perform a literature search for devices used in prone-position spine surgeries. A total of 7 devices was found; the authors explored these devices' features, advantages, and disadvantages. The cause of POVL seems to be a multifactorial problem with unclear pathophysiological mechanisms. Therefore, ocular compression is a critical factor, and eliminating any obvious compression to the eye with these devices could possibly prevent this devastating perioperative complication.
http://thejns.org/doi/pdf/10.3171/2009.8.FOCUS09151



Isquemia óptica despues de cirugía de columna.
Ischemic optic neuropathy following spine surgery.
Ho VT, Newman NJ, Song S, Ksiazek S, Roth S.
Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
J Neurosurg Anesthesiol. 2005 Jan;17(1):38-44.
Abstract
Perioperative visual loss (POVL) is a devastating injury that has been reported infrequently after nonocular surgery. The most common cause of POVL is ischemic optic neuropathy (ION). Increasing numbers of cases of ION are being reported after spine surgery, but the etiology of postoperative ION remains poorly understood. After a MEDLINE search of the literature, we reviewed published case reports of ION, specifically those reported after spine surgery performed with the patient in the prone position. Most of the cases involved posterior ION (PION, n = 17), and the remainder anterior (AION, n = 5). Most patients had no or few preoperative vascular disease risk factors. All except one PION and 2 of 5 AION cases reported symptom onset within the first 24 hours after surgery. Visual loss was frequently bilateral (40% of AION, 47% of PION cases). Mean operative time exceeded 450 minutes. The lowest average intraoperative mean arterial blood pressure was 64 mm Hg and the mean lowest intraoperative hematocrit was 27%. The average blood loss was 1.7 L for AION and 5 L for PION patients. PION patients received an average of 8 L of crystalloid solution and 2.2 L of colloid intraoperatively. This compilation of case reports suggests that a combination of prolonged surgery in the prone position, decreased ocular perfusion pressure, blood loss and anemia/hemodilution, and infusion of large quantities of intravenous fluids are some of the potential factors involved in the etiology of postoperative ION. However, levels of blood pressure and anemia intraoperatively were frequently at levels considered acceptable in anesthesia practice. The etiology of postoperative ION remains incompletely understood. Potential strategies to avoid this complication are discussed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699455/pdf/nihms-75440.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org