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University of Chicago 0.0000016% Mayo Clinic (Cx no cardiaca) 0.0008% Mayo Clinic (CABG) 0.06% John Hopkins (Cx Columna) 0.028% ASA POVL Registry 0.2 - 4.5% NIS (CABG) 0.08% NIS (Columna) 0.03% Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610 Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009 Nov;109(5):1534-45. Epub 2009 Aug 27. Pérdida de visión perioperatoria Se refiere a la alteración permanente o pérdida total de la visión durante un procedimiento de columna en el cual se administra anestesia general American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 Cámara Anterior Abrasión corneal Retina Oclusión Art. Central Retina Vías Retroquiásmicas Infartos origen embólico Lesión Nervio Óptico Neuropatía Óptica Isquémica Anterior Posterior Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610 Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Etiología: Compresión externa del globo ocular * Cabeza en mala posición PIO > PAM Generalmente unilateral Acompañado de otros signos de trauma periocular Ptosis Eritema Abrasión Corneal Oftalmoplegía CRITERIOS DIAGNÓSTICOS Retina pálida isquémica Punto rojo cereza en la mácula Defecto pupilar aferente Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. ANTERIOR Fondo de ojo temprano : disco edematoso con o sin hemorragias peripapilares en forma de llama Defecto aferente en reflejo pupilar POSTERIOR Fondo de ojo temprano : normal Defecto aferente en reflejo pupilar o ausencia del mismo Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Palidez del nervio óptico Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. ANTERIOR Irrigación: arterias ciliares posteriores POSTERIOR Irrigación: Plexo vascular de la pia y art central de la retina Dentro de cavidad ósea Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond). 2004 Nov;18(11):1188-206. Multifactorial Etiología Vascular: venosa vs arterial?? Pobre contenido de oxígeno Compresión local del plexo de la pia Aumento de presión venosa Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610 Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond). 2004 Nov;18(11):1188-206. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. Edad Presión sobre globo ocular Hipotensión Anemia Duración procedimiento Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8. American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 Paciente de Alto Riesgo Cirugía de Columna Prono Procedimiento prolongado Pérdida de sangre importante American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 No valoración preoperatoria por oftalmología o neuro-oftalmología Pacientes de alto riesgo explicar posibilidad de pérdida de visión Monitorizar presión arterial de forma continua en pacientes de alto riesgo Uso de técnicas hipotensivas no se asocia a aumento en el riesgo de POVL American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 Mantener volumen intravascular con coloides y cristaloides Considerar monitoreo de PVC en alto riesgo Monitorizar niveles de Hb-Hto en pacientes de alto riesgo con pérdida substancial de sangre No existe un límite definido ni un umbral para transfusión adecuado American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 Compresión no es causa de ION, pero debe prevenirse al ser causa de CRAO Mantener la cabeza a nivel o por encima del corazón Cabeza en posición neutra Evaluar posibilidad de hacer procedimiento por etapas American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28 Evaluar visión al recuperar conciencia Normal SI NO Valoración por oftalmología NO ION Examen Normal SI Manejar según causa Neuroimágenes NO Otra Causa SI American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28
