MARKED VISUAL IMPAIRMENT FROM THE VALSALVA MANEUVER DURING VITRECTOMY

Severe coughing during local or general anesthesia has resulted in massive suprachoroidal hemorrhage during vitrectomy.^[284] In seven patients (six who underwent general anesthesia and one, local anesthesia), "bucking" during endotracheal intubation or severe coughing during local anesthesia resulted in severe visual impairment. Obviously, care must be taken to avoid this outcome (also see Chapter 13 , Chapter 31 , and Chapter 65 ).