#JustReleased: 2019 Practice advisory for perioperative visu
An updated report on the “Practice Advisory for
Perioperative Visual Loss Associated with Spine Surgery' by the American Society of Anesthesiologists (ASA) Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care, has been published recently in the journal Anesthesiology. The present practice advisory replaces the one released in 2012.

This Advisory focuses on the perioperative management of patients who are undergoing spine procedures while they are positioned prone and receiving general anesthesia. This Advisory does not address the perioperative management of patients who receive regional anesthesia or sedation. In addition, this Advisory does not apply to spine surgery patients younger than 12 yr of age.

This Advisory is intended for use by anesthesiologists, neurosurgeons, neuro-ophthalmologists, and all other individuals who deliver or who are responsible for anesthesia or perioperative care. These individuals may include orthopedic surgeons, neurosurgeons, ophthalmologists, neuro-ophthalmologists, neurologists, nurse anesthetists, perioperative nurses, operating room nurses, and anesthesiology assistants.

The advisory has recommendations on the following topics
1. Intraoperative Management
• Blood Pressure Management
• Management of Blood Loss and Administration of Fluids
• Use of Vasopressors
• Patient and Head Positioning Devices
• Staging of Surgical Procedures

2. Postoperative Management

The key takeaways are:-
• Continually monitor systemic blood pressure in high-risk patients

• Check for the presence of preoperative hypertension, its degree of control, the preoperative use of antihypertensive drugs, and the patient’s risk of end-organ damage before using deliberate hypotension in a highrisk patient

• Periodically monitor hemoglobin or hematocrit values during surgery in high-risk patients who experience substantial blood loss

• Adrenergic agonists may be used on a case-by-case basis when it is necessary to correct for hypotension

• Position the high-risk patient so that the head is level with or higher than the rest of the body when possible

• Avoid direct pressure on the eye to prevent retinal artery occlusion

• Assess the vision of a high-risk patient when the patient becomes alert (e.g., in the recovery room, intensive care unit, or nursing floor)

• CT or MRI may be used on a case-by-case basis to rule out intracranial causes of visual loss as well as to visualize an abnormal optic nerve

Note: This list is a brief compilation of some of the key statement included in the practice advisory and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/Z1X1f