The most common cause of perioperative visual loss is ischemic
optic neuropathy, which may be attributed to perioperative anemia,
blood loss, hypotension, poor positioning, lack of monitoring and pro-
longed surgery, says William Landess, CRNA, MS, JD, corporate direc-
tor of anesthesia services at Palmetto Health in Columbia, S.C.
While patients with glaucoma, diabetes or obesity may be at a high-
er risk for vision loss, there is currently no pre-operative screening
test for ischemic optic neuropathy, since its causes are still largely
unknown. Ms. Van Wicklin says it's not a common incident, but peri-
operative vision loss "is a risk"— especially in prone, beach chair and
Trendelenburg positions.
Only use the prone position when it's necessary for a surgeon to
obtain good exposure, the experts say. Mr. Klev notes that in the posi-
tion, the patient's head must be kept in a neutral position, typically by
using a foam headrest. Your staff must be diligent in using the head-
rest correctly, he says. If using a popular style that features a 'T'
cutout, patients' eyes should be resting in the opening of the top of
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O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | A P R I L 2 0 1 5
z AVOID DISASTERS Be sure to float a patient's heels in supine position to avoid pressure ulcers.
Pamela
Bevelhymer,
RN,
BSN
