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Effect of the Degree of Reverse Trendelenburg Position on Intraocular Pressure during Prone Spine Surgery: A Randomized Controlled Trial.
MedLine Citation:
PMID:  24456677     Owner:  NLM     Status:  Publisher    
BACKGROUND CONTEXT: Postoperative vision loss complicates an estimated 1 in 1100 prone, spine surgical cases. This complication has been attributed to ischemic optic neuropathy, with one proposed reason being perioperative elevations in intraocular pressure (IOP). Previous research has studied the effects of table inclination on intraocular pressure in awake volunteers, however, the effects in spine surgery patients has not been investigated for reverse Trendelenburg positioning using a prospective, randomized controlled study design.
PURPOSE: To assess the effect of table inclination on intraocular pressure in patients undergoing prone spine surgery.
STUDY DESIGN: Single center, prospective, randomized controlled study PATIENT SAMPLE: Nineteen patients with no history of eye pathology, undergoing prone spine surgery at Dwight D. Eisenhower Army Medical Center were randomly assigned to a table position; neutral, 5, or 10 degrees of reverse Trendelenburg.
OUTCOME MEASURES: IOP, mean arterial pressure (MAP), estimated blood loss, fluid resuscitation, and ophthalmologic complication were assessed, before and after induction, and at incremental times during surgery, beginning at 30 minutes, 60 minutes, and 60 minute increments thereafter.
METHODS: No external funding was received for this work. Multivariate analyses evaluated surgical time, IOP, MAP, estimated blood loss, and fluid resuscitation as a function of table inclination to determine the effect of patient positioning on identified risk factors for postoperative vision loss.
RESULTS: Surgical times ranged from 33-325 minutes. A rapid increase in IOP was noted following prone positioning, with continued increases as time elapsed. The neutral group exhibited statistically higher IOP compared to the 5 degree reverse Trendelenburg group after 60 minutes and the 10 degree group through 60 minutes of surgery. The trend continued through 120 minutes, however, due to a lack of power, we were unable to determine statistical significance. There were no statistically significant differences between the 5 and 10 degree reverse Trendelenburg groups.
CONCLUSIONS: Reverse Trendelenburg positioning elicits decreased IOP compared to prone positioning for surgery times less than 120 minutes. Ten degrees of reverse Trendelenburg attenuates the rise in IOP during prone spine surgery superiorly in comparison to five degrees. No significant complications were associated with reverse Trendelenburg positioning.
Timothy Carey; K Aaron Shaw; Marissa L Weber; John G Devine
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-20
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  -     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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