Spine

UCSF Person

John Feiner, MD
Joyce Chang, MD

Clinical Resources

PeriOperative Visual Loss (POVL)

Central Retinal Vascular Occlusion (CRVO)…also known as Central Retinal Artery Occlusion (CRAO) and Central Retinal Venous Occlusion (CRVO)
a. Cause:

Miscellaneous Perioperative Medications

Antibiotics:
a. Elective spine procedures are typically clean cases and merit prophylactic antibiotics that cover skin flora. I & D cases may merit other coverage (e.g. for MRSA or anaerobes or GNRs).
b. Most common choice is Cefazolin

Protocol for Spine: Positioning

Bite Block:

a. Indications

Anesthesia & Neurophysiologic Monitoring

Monitoring techniques:

Venous & Arterial Access

Arterial lines:
a. Indications

Fluid Management

Total Fluids:
a. Data absent, but suggests running a little dry may reduce bleeding
b. ASA recommends limiting total fluids to reduce risk of POVL

Techniques for Reducing Bleeding

Controlled Hypotension:
a. Indications:

  • Proven to reduce blood loss in major spine surgery
  • Also shown to work for hip surgery and maxillofacial surgery

b. Contraindications:

Coagulation Factors

Assessment of coagulation status:
a. Standard labs:

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