COVER STORY Intraoperative complications . BY SANDRA

PREOPERATIVE PLANNING Reviewing your patient’s health status and medications preoperatively is mandatory. Someone with poorly controlled blood pressure or heart rate is at greater risk for suprachoroidal hemorrhage (SCH). I like my anesthesia team to know that the control of vital signs is important in glaucoma surgery. Anticoagulant use can contribute to more bleeding should an SCH occur, and any inessential use of aspirin or nonsteroidal drugs can easily be stopped 2 weeks prior to surgery.1 The discontinuation of more necessary anticoagulants for stroke prophylaxis, for example, needs to be determined on a case-by-case basis with the prescribing physician. The monitoring of warfarin dosing in patients undergoing filtering surgery should be up to date. To lessen coughing during surgery, I instruct patients on inhalers and/or nebulizers to use their medications on the day of surgery. I ask all patients to let the operative team know if they need to cough or move so that care may be taken to stabilize the eye. During surgery, note the red reflex. If you observe a choroidal effusion, the most important thing to do is to close the wound as quickly as possible to increase the IOP. This will help restrict the size of the effusion and limit any hemorrhage before it becomes expulsive. My scrub technician has my 10–0 nylon loaded in case I need it quickly.