Citation

Price TP, Ivashchenko A, Schurr MJ. Burns 2014; 40(4): e31-4.

Affiliation

Thomas Jefferson University, 1025 Walnut St. Suite 620, Philadelphia, PA 19107, United States; Division of Burn Surgery, University of Colorado Hospital, 12605 E. 16th Ave., Mail Stop F796, Aurora, CO 80045, United States.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.burns.2013.12.022

PMID

24468506

Abstract

Peri-operative visual loss is an uncommon and poorly understood entity whose severity launched a Practice Advisory to identify peri-operative risk factors including prone positioning, anemia, hypotension, blood loss >44.7% of EBV, and surgical time >4-6.5h. Contributing co-morbidities are obesity, tobacco, malnutrition, and PAD, which reduce blood flow to the optic nerve. We describe a patient with POVL focusing on the peri-operative course defined as the immediate preoperative assessment through discharge to compare the hospital course with previous reports of POVL in cardiac and spine operations.ss A middle-aged man admitted to the burn unit with 10% deep partial and full thickness burns to the back and neck underwent excision and autografting while prone. He was subsequently diagnosed with ischemic optic neuropathy and blindness. Co-morbidities were tobacco, malnutrition (albumin of 2.6g/dl), and obesity (BMI 30.1). Preoperative risk assessment included anemia and prone positioning. Intra-operative hypotension to SBP 75mmHg was noted. Operative duration was 5h. Blood loss was estimated to be 43.7% of EBV. Risk factors for POVL are present in many prone burn operations as these patients have long operative times and significant blood loss. Thus, minimization of these factors where possible is advised.

Language: en