Patients undergoing surgery and anesthesia commonly experience a decline in memory and learning capacity in the first week after surgery, but impairment can last up to 3 months in 10% of adult patients, according to recent research from Sweden.

The reason for these impairments remains unclear, say researchers, but a patient's age, morbidity and pre-existing cognitive impairments are significant risk factors. "In recent years, animal studies have shown that surgery itself can cause distinct changes in the parts of the brain involved in cognitive functions, as the inflammatory response to surgery leads to neuroinflammation-related disruption to cognitive abilities," says Lars I. Eriksson, professor of anesthesiology and intensive care at Karolinska Institutet in Stockholm.

Mark McGraw

In a rare but devastating complication that has long confounded surgeons, anesthesia providers and ophthalmologists, some healthy patients undergoing spinal fusion surgery suffer unexpected post-operative blindness. Writing in this month's issue of the journal Anesthesiology, researchers have identified patients at risk of and practices that contribute to this rare complication.

The vision defects, caused by ischemic optic neuropathy (ION), range from blurred vision to complete blindness, usually without significant recovery. The study's authors say obese male patients are at greater risk of suffering the complication. They also point to the use of a surgical frame that places the patient's head lower than the heart, which may exacerbate venous congestion and ultimately limit oxygen delivery to the optic nerve. Significant blood loss and subsequent fluid replacement also expose patients to the physiologic causes of ION, say the researchers.

Preventative strategies are the only viable option to reduce the complication's effects, for which treatment options have yet to be identified, notes the study. They include modifying table frame selection and patient positioning to keep the head at or above the heart during surgery; minimizing anesthesia duration; using colloids as well as crystalloids to maintain intravascular volume; and placing patients in positions that help reduce intra-abdominal pressure and venous congestion.

This is the largest study to date on blindness following spinal surgery, says lead author Lorri A. Lee, MD, an anesthesiologist from the University of Washington in Seattle. "Our identification of the major risk factors hopefully means that some can be modified in certain situations, with the potential to decrease the risk of blindness after major back surgery."

"Rare events are nearly impossible to study," says Mayo Clinic anesthesiologist Mark A. Warner, MD, in an accompanying editorial. "Until now, there have been no data to support speculation on etiologies of ION in spine fusion patients."

Daniel Cook

Suppose one of your nurses complains that a surgeon's off-color jokes have offended and threatened her. Is this sexual harassment? What if you know this surgeon has made similar remarks to everyone on your staff?

"Sexual harassment puts its victims in an uncomfortable position," writes Mark Peters, JD, a partner at the Nashville, Tenn., law firm Waller Lansden Dortch & Davis, "but not all uncomfortable situations are sexual harassment."

In an article for Outpatient Surgery Magazine, Mr. Peters, who represents healthcare employers in labor and employment issues, explains what legally constitutes sexual harassment. He considers how context, complicity and the "equal opportunity jerk defense" might affect interpretation. And, most importantly, he details the administrative actions you must take to protect your employees and shield your facility from liability.

David Bernard

Using the same vial of medication for more than one patient is strictly forbidden for many kinds of drugs, including propofol. Yet a new survey of New York State anethesiologists found that nearly half (49%) said they sometimes do just that. The survey, conducted by the New York State Society of Anesthesiologists and the New York City Department of Health and Mental Hygiene, also reports that about one-fourth of anethesiologists don't always use a new needle and syringe when drawing medication from a vial. Do your anesthesia providers use safe injection practices? Tell us in this week's InstaPoll.

Last week we asked if you thought testing new hires for nicotine - cigarettes, cigars, smokeless tobacco, snuff, nicotine patches and gum - as part of routine drug screening is a good idea. Of 531 responses: