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Being in a prone position may increase intraocular pressure leading to ischaemia, decreased perfusion pressure and blood supply to the retina. Adequate head and neck control is mandatory to prevent damage to the spinal cord, such as skeletal traction via Halo ring or Mayfield tongs. Positioning the patient is important to permit access to the surgical field and is necessary to avoid pressure areas or iatrogenic injuries. The first step in handling any intraoperative drop in spinal cord signal/function is increasing the blood pressure. This is more apparent in cases of traumatic spinal cord injury where the patient may already have a contused and swollen spinal cord. Maintaining adequate blood pressure is important for neural perfusion.
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A mean arterial pressure of 65 mm Hg or 20 mm Hg below baseline in normotensive patients is usually safe. At least 65% of the usual spinal blood flow is required for physiological integrity and a 12% decrease in blood flow may produce paralysis. Unwanted effects include spinal cord ischaemia and neurological damage.
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Manual inline axial stabilisation with fibre-optic nasal or oral endoscopy can reduce risk of spinal cord injury during tracheal intubation.Ĭontrolled hypotension reduces blood loss and facilitates surgical exposure. Forceful manipulation during laryngoscopy and tracheal intubation may jeopardise the spinal cord. During induction of general anaesthesia in patients with cervical instabilities, no protective mechanism exists for the compromised spinal cord due to the paralysed neck musculature. This is likely caused by trauma to the anterior soft-tissue and prolonged prone position both can result in upper airway oedema and impaired respiration. Here is a list of our partners who offer products that we have affiliate links for.The reported incidence of postoperative respiratory compromise varies from 0%–14%. While we work hard to provide accurate and up to date information that we think you will find relevant, Forbes Advisor does not and cannot guarantee that any information provided is complete and makes no representations or warranties in connection thereto, nor to the accuracy or applicability thereof. The compensation we receive from advertisers does not influence the recommendations or advice our editorial team provides in our articles or otherwise impact any of the editorial content on Forbes Advisor. Second, we also include links to advertisers’ offers in some of our articles these “affiliate links” may generate income for our site when you click on them. This site does not include all companies or products available within the market. The compensation we receive for those placements affects how and where advertisers’ offers appear on the site. First, we provide paid placements to advertisers to present their offers. This compensation comes from two main sources.
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