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The increasing use of coronary artery angioplasty with deployment of stents for treatment of coronary artery disease poses several dilemmas for perioperative management. These conflicting requirements are manifested most acutely in the management of patients with neurovascular disease. This chapter presents a case study of a 51-year-old female with a past medical history of ischemic heart disease, hypertension, and undifferentiated autoimmune disease with interstitial lung involvement, as an example. The presence of coronary stents in patients undergoing neurosurgical procedures warrants specific consideration prior to anesthesia. It is necessary to balance the risks of stent thrombosis, and the subsequent risk of myocardial infarction, arrhythmia, or cardiac arrest, against the risks of hemorrhage during or after a neurosurgical procedure. There is currently an irresolvable conflict between the risks of with holding and continuing antiplatelet agents in the perioperative period.
Visual disturbances are known to occur after spine surgery; this chapter describes a case of postoperative diplopia. This chapter presents a case study of a 34-year-old woman presented to the clinic with post-laminectomy kyphosis and subsequently underwent posterior fusion and fixation in the prone position. The patient developed facial edema and reported diplopia on the first postoperative day. Abducens nerve palsy, which causes diplopia without any other neurologic signs, is reported to be the most common cranial nerve palsy. Abducens nerve palsy was reported to be a complication of different procedures such as lumbar puncture, shunt surgery, maxillary osteotomy, cranial trauma, and skull traction. Prone spine cases are associated with postoperative visual disturbances. The present case suggests that diplopia in this context may be a self-limiting process due to sixth nerve stretch after fluid overload.