Perioperative Visual Loss Associated with Spine Surgery
Summary of Advisory Statements
Preoperative Patient Evaluation and Preparation
- Determine on a case-by-case basis whether or not to inform patients who are not anticipated to be “high-risk” for visual loss.
Intraoperative Management
Blood Pressure Management
-
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 high-risk patient.
-
Discuss with the surgeon whether deliberate hypotension is necessary.
-
-
Maintain arterial pressure at higher levels in hypertensive patients to prevent risks to end organs.
- Use deliberate hypotension in high-risk patients only when the anesthesiologist and surgeon agree that its use is essential.
-
Treat prolonged significant decreases in blood pressure.
-
Management of Blood Loss and Administration of Fluids
- Use transfusions of blood as deemed appropriate.
- Crystalloids or colloids alone or in combination may be used to maintain adequate replacement of intravascular volume.
Use of Vasopressors
Adrenergic agonists may be used on a case-by-case basis when it is necessary to correct for hypotension.
Patient and Head Positioning Devices
- Maintain the high-risk patient’s head in a neutral forward position (e.g., without significant neck flexion, extension, lateral flexion, or rotation) when possible.
- A head holder may be applied by the spine surgeon in patients in whom head positioning is challenging.
Staging of Surgical Procedures
Postoperative Management
- If there is concern regarding potential visual loss, obtain an urgent ophthalmologic consultation to determine its cause.
- Computerized tomography or magnetic resonance imaging 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.
- Additional management may include optimizing hemoglobin or hematocrit values, hemodynamic status, and arterial oxygenation.
Recommendation Grading
Overview
Title
Perioperative Visual Loss Associated with Spine Surgery
Authoring Organization
American Society of Anesthesiologists
Publication Month/Year
January 1, 2019
Last Updated Month/Year
January 23, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this Advisory is to enhance awareness and reduce the frequency of perioperative visual loss during and after spine surgery.
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Intended Users
Nurse anesthetist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D018917 - Optic Neuropathy, Ischemic, D015356 - Retinal Artery Occlusion
Keywords
anesthesia, perioperative, perioperative visual loss, Visual loss
Source Citation
Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care*. Anesthesiology 2019;130(1):12-30.