Attendee Questionnaire and Survey
(APSF-Sponsored POVL Conference, September 12, 2012,
Phoenix, AZ)
Conference Attendees (n-87)

Anesthesia Professionals (n-74) (anesthesiologists, CRNAs, AAs) (surveys returned, 67)

Physicians (n-4) (neuro-ophthalmologist, neurosurgeon, orthopedic surgeon, robotic
surgeon) (surveys returned, 3)

Non-Physicians (n-8) (two risk managers, insurer, pharmacy, VA safety officer, APSF, PhD
researcher, ophthalmology practice administrator) (surveys returned, 8)

Industry (one representative) (survey returned)
*****************************************************************************************************
Analysis of Anesthesia Professional’s Questionnaire and Survey
Responses (number of responses and percentages)
1.
My principal affiliation as an attendee at this conference is:
A.
B.
C.
2.
My Breakout Group assignment is:
A.
B.
C.
D
3.
1
2
3
4
17
18
12
19
I have cared for a patient who experienced ION.
A.
B.
C.
D.
4.
Anesthesia Professional
67
Physician (not an anesthesiologist)
Non-physician
No
Yes (one patient)
Yes (more than one patient)
Not applicable
51
12
04
0
76.1%
17.9%
6.0%
I have NOT cared for a patient who developed ION but I am aware of this complication occurring
in my hospital/practice group.
5
A.
B.
C.
D.
5.
No
Yes (one patient)
Yes (more than one patient)
Not applicable
25
15
15
09
39.1%
23.4%
23.4%
14.1%
I have cared for a patient who experienced CRAO.
A.
No
64
95.5%
B.
C.
D.
6.
49
07
08
02
73.1%
10.4%
11.9%
3.3%
Agree
Disagree
No opinion
58
05
04
86.6%
7.5%
6.0%
Agree
Disagree
No opinion
35
30
02
52.2%
44.8%
3.0%
Contributory risk factors for ION can be modified or eliminated by the:
A.
B.
C.
D.
10.
No
Yes (one patient)
Yes (more than one patient)
Not applicable
It is my opinion that most anesthesia professionals do not recognize the risk of ION in the
susceptible patient population.
A.
B.
C.
9
4.5%
It is my opinion that most surgeons do not recognize the risk of ION in the susceptible patient
population.
A.
B.
C.
8.
03
0
0
I have NOT cared for a patient who developed CRAO but I am aware of this complication
occurring in my hospital/practice group.
A.
B.
C.
D.
7.
Yes (one patient)
Yes (more than one patient)
Not applicable
Anesthesia Professional
Surgeon
Both the Anesthesia Professional and Surgeon
No opinion
0
04
55
05
6.3%
85.9%
7.8%
ION should be included in the informed consent for (all that apply):
A.
B.
C.
D.
E.
F.
G.
H.
I.
All patients undergoing spine surgery in the prone position
Only patients undergoing spine surgery in the prone position who are considered “at risk”
All patients undergoing surgery in the steep head-down position
Only patients undergoing surgery in the head-down position who are considered “at risk”
Separate for surgery
Separate for anesthesia
Combined for surgery and anesthesia
Incidence too low to justify inclusion in the informed consent
No opinion
Most Common Combinations (67 responses):
ACG
14
20.9%
AC
06
9.0%
BDG
05
7.5%
A
05
7.5%
BG
04
6.0%
G
04
6.0%
11.
CRAO caused by external globe compression can be reliably prevented by periodic eye checks:
A.
Agree
46
68.7%
B.
C.
12.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
55
0
02
10
82.1%
3.0%
14.9%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
07
42
08
10
10.4%
62.7%
11.9%
14.9%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
34
10
10
13
50.7%
14.9%
14.9%
19.4%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
57
07
0
03
85.1%
10.4%
4.5%
A balance between colloid and crystalloid fluid administration has an impact on the potential for
developing ION.
A.
B.
C.
D.
18.
9.2%
69.2%
6.2%
15.4%
Controlled hypotension should not be utilized routinely in patients considered to be at risk for
ION.
A.
B.
C.
D.
17.
06
45
04
10
If laparoscopic procedures in the steep head-down position are anticipated to be prolonged (based
on earlier definition), then consideration should be given to performing the procedure open to
decrease the risk of ION.
A.
B.
C.
D.
16.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
Staged spine procedures to decrease the risk of ION introduce too high a risk (infection,
thromboembolism, neurologic injury, financial cost) to consider as an option even when the
surgical procedure is prolonged.
A.
B.
C.
D.
15.
29.9%
1.5%
When the duration of spine surgery is anticipated to be prolonged (preoperatively) or becomes
prolonged (intraoperatively), consideration should be given to the use of staged spine procedures
in an attempt to decrease the risk of ION.
A.
B.
C.
D.
14.
20
01
A preoperative ophthalmic or neuro-ophthalmic evaluation is effective for identifying patients at
risk for ION.
A.
B.
C.
D.
13.
Disagree
No opinion
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
58
03
0
06
86.6%
4.5%
9.0%
Intravascular volume status should be monitored continuously in patients considered to be at risk
for ION.
A.
B.
C.
D.
19.
92.3%
3.1%
4.6%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
02
58
0
07
3.0%
86.6%
10.4%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
22
11
02
32
32.8%
16.4%
3.0%
47.8%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
64
0
0
02
97.0%
3.0%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
30
25
0
02
44.8%
37.3%
3.0%
There is no proven treatment (steroids, antiplatelet agents, intraocular pressure lowering agents)
for ION when it manifests postoperatively.
A.
B.
C.
D.
25.
60
02
0
03
There is no pathophysiological mechanism by which facial edema can cause ION.
A.
B.
C.
D.
24.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
During spine surgery, the patient’s head should be positioned level with or higher than the heart in
patients considered to be at risk for ION.
A.
B.
C.
D.
23.
11.9%
Prolonged use of high-dose alpha-adrenergic agonists during surgery may reduce optic nerve
perfusion and increase the risk of ION.
A.
B.
C.
D.
22.
74.6%
13.4%
A specific transfusion threshold that would reduce the risk of ION related to anemia is known.
A.
B.
C.
D.
21.
50
09
0
08
Hemoglobin or hematocrit values should be monitored periodically to detect anemia in patients
considered to be at risk for ION.
A.
B.
C.
D.
20.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
60
01
03
03
89.6%
1.5%
4.5%
4.5%
Male gender, obesity, decreased percent colloid administration and use of the Wilson frame should
be added to the risk factors for developing ION following spine surgery (Anesthesiology
2012:116:15).
A.
B.
C.
D.
26.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
15
07
06
39
22.4%
10.4%
9.0%
58.2%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
60
02
0
05
89.6%
3.0%
7.5%
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
57
0
0
10
85/1%
14.9%
This conference achieved its stated goal for “ultimately creating a participant-developed,
moderator-led statement of safety recommendations (best practices) for managing patients
considered to be at risk for POVL.”
A.
B.
C.
30.
6.0%
A best practices management protocol and recommendations to decrease the risk of ION should be
based on steps to decrease the likelihood of venous congestion and edema formation in the
periorbital area/head.
A.
B.
C.
D.
29.
94.0%
Despite the multifactorial nature of ION and the often incomplete answers to its etiology and
prevention, the best option currently available for patients and those responsible for their care is to
create and adopt a universal best practices management protocol and recommendations (based on
current knowledge and understanding) and to apply this to the intraoperative management of all
patients considered to be at risk for ION.
A.
B.
C.
D.
28.
63
0
0
04
The increased incidence of ION in males may imply a neuroprotective effect of estrogen.
A.
B.
C.
D.
27.
Agree
Disagree
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
Agree
Disagree
No opinion
47
04
16
70.1%
6.0%
23.9%
As a result of this conference, I intend to develop multidisciplinary guidelines in my institution to
address identification, consent, and perioperative management of patients considered at risk for
ION.
A.
B.
C.
D.
E.
Yes
No
Will consider
No opinion (outside my area of expertise)
No opinion (data/evidence insufficient to support an opinion)
32
04
29
01
01
47.8%
6.0%
43.3%
1.5%
1.5%