Most Common Causes of Perioperative Visual Loss Corneal abrasion Retinal ischemia Ischemic optic neuropathy Symptoms Painful foreign body sensation, visual acuity may be intact Painless loss of vision Unilateral Periorbital edema Proptosis Chemosis Extraocular muscle injury Ecchymosis Painless loss of vision Bilateral Etiology Corneal epithelial defect in anterior segment Central retinal artery occlusion Branch retinal artery occlusion (retinal microemboli or vasospasm) Elevated intraocular pressure Unknown, perhaps related to optic nerve ischemia, vascular insufficiency, although often no other clinically significant end-organ damage Risk factors Unprotected, exposed eyes Intraoperative contact lens use Prone positioning Spine surgery Cardiac surgery, bypass External orbital pressure Prone positioning Spine surgery (PION) Cardiac surgery (AION) Prolonged surgery ?Deliberate hypotension ?Hypoxia ?Hemodilution ?Vasoconstrictors ?Anemia ?Elevated venous pressure (e.g., Trendelenbur...
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Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is caffeine prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
22G Quincke = 36% 27G Whitacre = 0% 16G Tuohy = 70% Dural puncture occurs 0–2.6% of the time an epidural is placed for labor analgesia
Purpose We assessed the ability of bispectral index (BIS) to predict clinical outcome (dead or alive within 2 weeks). Methods In total, 90 coma patients with severe brain injuries underwent BIS monitoring, and serum neuron-specific enolase (NSE) and S100 protein levels were assayed within the first 3 days of admission. Receiver operator characteristic (ROC) curve analysis was used to assess the performance of BIS values for predicting death within 2 weeks. A cutoff value was calculated using the Youden index. Results A significant negative correlation was found between BIS value and serum NSE and S100 levels. The area under the curve for BIS value was 0.841 ( p < 0.001, 95 % CI = 0.751–0.931), and higher than for NSE (0.713) ( p = 0.002, 95 % CI = 0.582–0.844) or S100 (0.790) ( p < 0.001, 95 % CI = 0.680–0.899). The optimal cutoff of BIS was 32.5. Serum NSE and S100 protein levels and the ...
What is the risk of thrombolysis in a patient with recent surgery, previous stroke or intracranial space-occupying lesion? Thrombolysis after recent surgery They identi fi ed 25 reports, including 64 patients, thrombolysed (the majority for PE) following major recent surgery. Major bleeding occurred in >50% of patients receiving thrombolysis within 1week of surgery and in 20% of patients thrombolysed 1 – 2 weeks post- operatively. American College of Chest Physicians (ACCP) guidelines suggest that recent surgery (excluding recent brain or spinal surgery or trauma) is a relative contraindication and that the bleeding risk reduces signi fi cantly 2 weeks after surgery. Thrombolysis in the presence of intracranial space-occupying lesions? A review of 12 patients with intracranial neoplasms thrombolysed for various indications identi fi ed ICH in a single patient (8.3%). Guillan et al identi fi ed fi ve cases ( fi ve meningiomas, one choles- teatoma ...
The most common electrocardiographic changes of acute right-heart overload/failure Sinus tachycardia T-wave inversion in leads V1-V4, III and aVF Incomplete or complete right bundle branch block Cardiac axis tilt >90° S-wave in lead I and Q wave in lead III Atrial fibrillation P pulmonale in leads II and III ST-segment elevation in leads V1-V2