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doi: 10.1097/
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Repositioning during robotic procedures to prevent postoperative visual loss

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INSTRUCTIONS Repositioning during robotic procedures to prevent postoperative visual loss


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Repositioning during robotic procedures to prevent postoperative visual loss

General Purpose: The purpose of this learning activity is to provide information about preventing POVL. Learning Objectives: After reading this article and taking this test, you will be able to: 1. Explain the pathophysiology and signs/symptoms of POVL. 2. Identify the advantages and disadvantages of robotic laparoscopic procedures. 3. Select successful interventions to prevent POVL.

1. POVL is known to occur in association with

a. excessive tourniquet pressure on the upper limbs.

b. spinal surgery.

c. severe post-operative nausea.

d. rising intracranial pressure during surgery.

2. The specific cause of POVL is

a. compromised blood flow to the optic nerve.

b. increased pressure on the optic nerve.

c. excessive oxygen supply to the optic nerve.

d. uncertain.

3. Decreased blood supply to the optic nerve leads to

a. scleral edema.

b. retinal vascular neuropathy.

c. ischemic optic neuropathy.

d. retinal vascular stenosis.

4. One of the most predictive factors for reaching the critical IOP threshold may be

a. increased baseline IOP prior to anesthesia.

b. the absence of chemosis after supine positioning.

c. corneal swelling prior to supine positioning.

d. decreased baseline IOP prior to surgery.

5. Comorbid conditions predisposing a patient to POVL include all of the following except

a. coronary artery disease.

b. hypothyroidism.

c. diabetes.

d. hypertension.

6. Which sign observed in patients after ST positioning should prompt a postoperative visual acuity assessment?

a. clouded lens

b. darkened sclera

c. chemosis

d. dilated pupils

7. One advantage of ST positioning is that

a. it increases renal blood flow.

b. it aids oxygenation of abdominal organs.

c. it reduces venous congestion of the face and ocular area.

d. gravity pulls abdominal contents out of the surgical field.

8. Which is not a result of abdominal insufflation during laparoscopy?

a. increased lung compliance

b. bradycardia

c. asystole

d. decreased cardiac output

9. A major benefit of robotic procedures is that they

a. allow the surgeon to be close to the surgical field.

b. reduce assistant fatigue from holding instruments steady.

c. decrease the length of exposure to general anesthesia.

d. decrease procedural costs.

10. Potential disadvantages of robotic procedures include all of the following except

a. limited tactile feedback.

b. increased length of surgical time.

c. decreased three-dimensional visualization in real time.

d. the inability to reposition patients while the robot is in place.

11. One intervention aimed at managing POVL is

a. administering dorzolamide hydrochloride-timolol ophthalmic solution.

b. a visual check 6 hours postoperatively.

c. an LSI for 5 minutes after 2 hours of ST.

d. switching to a constant level supine position after 3 hours of ST.

12. The risk of POVL in the ST position is compounded by the

a. length of surgical cases lasting 2 to 3 hours.

b. inability to reposition patients during robotic procedures.

c. difficulty of disengaging the robotic arm during surgery.

d. length of time needed to reprogram the robot after a pause in surgery.

13. Research has shown that the percentage of patients who had a return to baseline IOP after receiving LSI was

a. 75%.

b. 80%.

c. 90%.

d. 95%.

14. During lengthy ST procedures, research supports an LSI of

a. 2-4 minutes.

b. 5-7 minutes.

c. 8-10 minutes.

d. 10-12 minutes.

15. Returning the patient to a level supine position from ST is key in order to

a. alleviate pressure on the diaphragm.

b. lower IOP to less than critical levels.

c. relieve excessive intracranial pressure.

d. facilitate blood flow to the lower extremities.

16. The intervention of LSI

a. eliminates the major cause of POVL.

b. needs further study to determine its value in eliminating POVL.

c. may decrease a contributing cause of POVL.

d. eliminates the major risk factor for ION.

17. The administration of dorzolamide hydrochloride-timolol ophthalmic solution to reduce critical IOP

a. does not require surgical interruption.

b. should be given at the end of surgery.

c. requires measurement of IOP so the dose can be titrated accurately.

d. should be prophylactically given preoperatively.

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