Perioperative Visual Loss

Case Synopsis

A 49-year-old man weighing 125 kg is scheduled for decompression laminectomy and instrumented fusion of the lumbar spine at multiple levels for lumbar stenosis. General anesthesia proceeds uneventfully with prone positioning, and the patient’s face and eyes are protected from direct pressure with a horseshoe headrest. Somatosensory evoked potentials are monitored intraoperatively. The surgery lasts 8 hours with an estimated blood loss of 2.5 L, replaced with intravenous (IV) blood transfusion, crystalloid, and antifibrinolytic therapy. The lowest hematocrit reading is 25%. On postoperative day 2, the patient complains of blurred vision in both eyes.