Repositioning during robotic procedures to prevent postoperative visual loss

Freshcoln, Michelle; Diehl, María

doi:10.1097/01.orn.0000451045.05365.94

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…Numerous risk factors for postoperative vision loss have been identified that include older patients with elevated baseline IOPs; patients with existing hypertension, diabetes, obesity, anemia, vascular disease, increased blood viscosity; and patients who smoke, as well as patients who experience intraoperative hypotension, blood transfusion, lower colloid use during fluid administration, or prolonged surgical times, and patients who are positioned on horseshoe-shaped headrests. 25,38,45,46 Patients who are predisposed to acute angle-closure glaucoma are also at high risk for ocular injury even during short procedures because the prone position can shift the lens-iris diaphragm forward so it obstructs aqueous humor outflow and increases IOP. 20…”

Section: Risk Factors For Postoperative Vision Lossmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Wicklin

2020

Int J Spine Surg

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Background: Patients undergoing surgery in the prone position may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients. The research question to be addressed is ''What is the magnitude of the increase in intraocular pressure at specific perioperative time points in adults undergoing surgery in the prone position?''Methods: Comprehensive search strategies were used to identify nine eligible studies (N ¼ 229). Standardized mean difference effect sizes were calculated for two intraoperative time points. Time points for meta-analysis were selected to achieve the greatest number of comparisons for analysis at each time point. Prediction intervals for each time point were also calculated to show the dispersion of true effect sizes around the mean.Results: Meta-analysis showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position (T1: standardized mean difference [d] ¼ 2.55; P , .001) and continued to increase significantly until the end of the prone position (T2: d ¼ 3.44; P ¼ .002).Conclusions: Intraocular pressure increases of this magnitude demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the prone position.Clinical Relevance: Implementing preoperative ophthalmologic examinations for patients undergoing surgery in the prone position may help to reduce the risk for ocular injury. Intraoperative interventions that can be implemented to reduce or mitigate the increase in intraocular pressure include implementing a 5-to 10-degree reverse Trendelenburg prone position, reducing the amount of time the patient is in the prone position, considering staged procedures, monitoring intraocular pressure, providing periodic position changes or rest periods, preventing pressure on the eye, and administering specific medications or anesthetics. ComplicationsKeywords: intraocular pressure, prone position, ischemic optic neuropathy, central retinal artery occlusion Pathogenesis of Postoperative Vision LossPostoperative vision loss in patients undergoing surgery in the prone position is generally related to 1 PurposeAlthough some researchers have studied the quantitative increase of IOP in surgical patients in the prone position, 1,2,14,16,17,34,50 there is a need for systematic review and meta-analyses of these studies to demonstrate the overall effect size and provide high-quality evidence supporting, or negating, the

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Section: Risk Factors For Postoperative Vision Lossmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Wicklin

2020

Int J Spine Surg

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Systematic review and meta-analysis of Trendelenburg position on intraocular pressure in adults undergoing surgery

Wicklin¹

2019

Ann. Laparosc. Endosc. Surg

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Risk Factors for Increased Intraocular Pressure and Ophthalmic Complications During Robot-Assisted Laparoscopic Prostatectomy

Lutfarakhmanov,

Lifanova,

Mironov

et al. 2024

Ocular Hypertension - New Advances

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Robot-assisted laparoscopic prostatectomy (RALP) is the most effective treatment option for prostate cancer. Special conditions of the operation affect intraocular pressure (IOP). The purpose of this review was to systematize new data on changes in IOP during RALP, to review the ophthalmic complications related to the robot-assisted approach, and to suggest measures to avoid such issues. A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RALP procedures focused on positioning, access, and operative technique considerations. Several complications in RALP procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscle injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. The robotic surgical team must be careful and work together to avoid possible complications. This review offers the first assessment of perioperative changes in IOP and ophthalmic complications during RALP and several steps in surgical planning to reach this goal. Further studies with a longer follow-up period are necessary to determine the clinical efficacy and safety of various types of general anesthesia.

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Repositioning during robotic procedures to prevent postoperative visual loss

Cited by 3 publications

References 8 publications

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Systematic review and meta-analysis of Trendelenburg position on intraocular pressure in adults undergoing surgery

Risk Factors for Increased Intraocular Pressure and Ophthalmic Complications During Robot-Assisted Laparoscopic Prostatectomy

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