Table 1.
Recommendations of the ASA Task Force on Perioperative Blindness
| The consensus of the Task Force is that a high-risk patient's vision should be assessed when the patient becomes alert (e.g. in the recovery room, intensive care unit, or nursing floor). If there is concern regarding potential visual loss, an urgent ophthalmologic consultation should be obtained to determine its cause. Additional management may include optimizing haemoglobin or haematocrit levels, haemodynamic status, and arterial oxygenation. To rule out intracranial causes of visual loss, consider magnetic resonance imaging. The Task Force believes that there is no role for antiplatelet agents, steroids, or intraocular pressure-lowering agents in the treatment of perioperative ischaemic optic neuropathy |
| There is a subset of patients who undergo spine procedures while they are positioned prone and receiving general anaesthesia who have an increased risk for the development of perioperative visual loss. This subset includes patients who are anticipated before operation to undergo procedures that are prolonged, have substantial blood loss, or both (high-risk patients) |
| Consider informing high-risk patients that there is a small, unpredictable risk of perioperative visual loss |
| The use of deliberate hypotensive techniques during spine surgery has not been shown to be associated with the development of perioperative visual loss |
| Colloids should be used along with crystalloids to maintain intravascular volume in patients who have substantial blood loss |
| At this time, there is no apparent transfusion threshold that would eliminate the risk of perioperative visual loss related to anaemia |
| High-risk patients should be positioned with the head level with or higher than the heart when possible. In addition, the head should be maintained in a neutral forward position (e.g. without significant neck flexion, extension, lateral flexion, or rotation) when possible |
| Consideration should be given to the use of staged spine procedures in high-risk patients |
| Available from http://www.asahq.org/publicationsAndServices/BlindnessAdvisoryFinal.pdf |