Changes in Intraocular Pressure due to Surgical Positioning

Walick, Kristina S.; Kragh, John E; Ward, John A.; Crawford, John J.

doi:10.1097/brs.0b013e318158cc23

Cited by 53 publications

(24 citation statements)

References 48 publications

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“…Raised intraocular pressure in combination with raised intra-abdominal pressure reduces venous return in the orbit increasing venous pressure and edema. 14,22,35 Edema can be aggravated by high-volume fluid replacement aggravating intraocular pressure.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…34,22 Decreased perfusion pressure on the optic nerve results in ION. 22,35 ION and OCS are well-established risk even with sufficient supportive facial padding.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…49 If the Trendelenburg position is required during surgery, minimize time with the head below heart level. 35 Direct pressure on the orbits should be avoided and use of headrests that ensure pressure is off the orbits and ears is advised. 7,31,38,48 Asok et al recommends the Mayfield head clamp to prevent external pressure on the orbit.…”

Section: Recommendationsmentioning

confidence: 99%

“…13 Maintaining tight control of hemostasis, monitoring blood pressure by arterial line or central venous pressure line, and timely correction of anemia and hypotension is paramount. 16,31,35,36,48 Lower transfusion threshold and maintaining hematocrit above 30% in high risk patients is recommended.…”

Section: Recommendationsmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

215

162

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…34,22 Decreased perfusion pressure on the optic nerve results in ION. 22,35 ION and OCS are well-established risk even with sufficient supportive facial padding.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

215

162

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“…PCNL was initially performed in the prone position. However, this approach has numerous inherent drawbacks, including patient discomfort, a potential risk for vision loss, and circulatory, hemodynamic and ventilatory difficulties, particularly in obese patients [3,4]. To overcome these drawbacks, PCNL in the supine position has also been described [5].…”

Section: Introductionmentioning

confidence: 99%

Supine Lithotomy versus Prone Position in Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

Zhan

Zhou

et al. 2013

Urol Int

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Objective: To compare operative time, safety and effectiveness of minimally invasive percutaneous nephrolithotomy (MPCNL) in the supine lithotomy versus prone position. Methods: Between January 2008 and December 2010, a total of 109 consecutive patients with upper urinary tract calculi were enrolled and randomly divided into group A (53 patients, supine lithotomy position) and group B (56 patients, prone position). The MPCNL procedures were performed under the guidance of real-time grayscale ultrasound system. The preoperative characteristics, intraoperative and postoperative parameters were analyzed and compared. Results: All patients were successfully operated. There was no signiﬁcant difference between the two groups in stone-free rate (group A 90.1 vs. group B 87.5%, p = 0.45), mean blood loss, number of access tracts, calyx puncture, mean hospital stay (group A 6 ± 1.1 vs. group B 6 ± 1.5 days, p = 0.38) and complications. But the operative time was significantly shortened in supine lithotomy position (group A 56 ± 15 vs. group B 86 ± 23 min, p < 0.001). Conclusions: The effectiveness and safety of the supine lithotomy position for MPCNL were similar to the prone position. However, the supine lithotomy position has an important advantage of reducing the operative time. The supine lithotomy position could be a good choice to perform MPCNL.

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Complications Experienced by Prostate Cancer Patients in the Era of Robot-Assisted Radical Prostatectomy

Masuda

2024

Interdisciplinary Cancer Research

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Changes in Intraocular Pressure due to Surgical Positioning

Abstract: IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.

Cited by 53 publications

References 48 publications

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Supine Lithotomy versus Prone Position in Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

Complications Experienced by Prostate Cancer Patients in the Era of Robot-Assisted Radical Prostatectomy

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