11/30/2023 0 Comments Unilateral blown pupilResidual neuromuscular paralysis was reversed with 2.5 mg of neostigmine and 0.5 mg of glycopyrrolate. After completion of surgery patient was turned into supine position. Intraoperative period was uneventful and there was minimal blood loss of approximately 200-300 mL. All the vulnerable pressure points were padded. Eyes were checked and there was no direct pressure on eyes. Following induction of anesthesia, the patient was turned into prone position with body being supported on gel bolsters and head was kept on head rest with eyes at the same level of heart. Anesthesia was maintained with oxygen, nitrous oxide, sevoflurane and vecuronium as muscle relaxant. Patient was induced with fentanyl 1.5 mcg.kg −1 IV, propofol 2 mg.kg −1 IV and vecuronium 0.1 mg.kg −1 IV and intubated with 8.0 mm cuffed flexometallic/armored endotracheal tube. All the standard ASA monitors were attached and peripheral Intra Venous (IV) line was secured. On the day of surgery patient was taken into Operation Theatre after confirming the Nil Per Oral (NPO) status. Premedication was given in the form of tablet Ranitidine 150 mg and tablet Alprazolam 0.25 mg, the night before and on the day of surgery. All laboratory investigations were within normal limits. He was a known hypertensive on tablet Amlodipine 5 mg once daily since 10 years. General and systemic examinations was within normal limits. Case reportĪ 48 year old male patient with history of hypertension (ASA-II) presented with multiple level prolapsed intervertebral disc (L4-L5, L5-S1) with radicular pain in both the lower extremities, was planned for microdiscectomies. Here, we report a case of middle-aged patient who developed dilated left pupil following lumbar microdiscetomy in prone position. There is no current literature about development of unilateral pupillary dilatation leading to anisocoria as a complication of spine surgery performed under prone position. Corneal and scleral injuries are the most common ophthalmologic injuries. Postoperative visual disturbances after non-ophthalmic surgery. 3 3 Kawaguchi M, Hayashi H, Kurita N, et al. Reported incidence of visual disturbances ranges from 0.028 to 0.2% after spine surgery. Among ophthalmological complications Perioperative Visual Loss (POVL) is a relatively uncommon but devastating complication of spine surgery, particularly when spine fusion is performed. Neurovascular complications from malposition on the operating table. In 1948 ophthalmologic complication following prone positioning was first reported by Slocum et al. Complications associated with prone positioning in elective spinal surgery. 1 1 DePasse JM, Palumbo MA, Haque M, et al. However prone positioning may be associated with variety of complications including hemodynamic instability, ophthalmological complications, central nervous system complications, peripheral nerve compression injuries, compartment syndrome and pressure ulcers. Prone position is a surgical position commonly used to access posterior cranial fossa, spine, retroperitoneal structures and surgeries involving gluteal region and lower limbs.
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