Authors

  • Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Comments

mkeamy

Your colleague, Warner, I think, gives a very good talk on this topic. Clearly, the phenomenon is ischemic, and hypotension probably plays a significant role. Warner claims that art of the pathophyisology involves pharmacologic paralysis; that paralyzing the extra-ocular muscles causes the globes to hang from the optic nerve, constricting the central retinal artery. I do a lot of complex spine, and I do not use induced hypotension, nor do I paralyze for any longer than necessary to establish exposure; the BIS helps with this. Incidentally, I favor vasopressin over neo- can't tell ya why, just like it.

mkeamy

why Bis of 55? why not 45 or 50? why Hgb of 10? If you are worried aout IOP, how about acetazolamide?

andrew kofke

lower bis=lower bp
hb of 10 based on studies on optimization studies both systemically and neuro (Dexter JNA) and brain phys which suggests active vasocilation in brain starts about Hb 10. So if there is compromised reserve (eg already maximal vasodil and unable to dilate more for anemia) injury can arise. of course no one knows if this physiology applies to the eye.

dont know what acetazolamide would do for the increased iop. In the brain it increases cbf to increase icp before it decreases it from decreased csf production.

ak

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