Changes in intraocular pressure during coronary artery bypass graft surgery: an observational study
Mudanças na pressão intraocular durante a cirurgia de revascularização do miocárdio: um estudo observacional
Gokhan Erol, Suat Doganci, Naim Boran Tumer, Atike Tekeli Kunt, Vedat Yildirim
Abstract
Background
In this study, the effects of pulsatile and non-pulsatile on-pump Coronary Artery Bypass Graft surgery (CABG) and off-pump CABG techniques on the intraocular pressure were investigated.
Methods
Forty-five patients who planned to elective coronary artery bypass surgery with on-pump pulsatile (n = 15), non-pulsatile (n = 15), or off-pump (n = 15) were included. Intraocular Pressure (IOP) measurements were performed on both eyes at nine time-points: 1) Before the operation, 2) After anesthesia induction, 3) 3-minutes after heparin administration Left Internal Mammary Artery (LIMA) harvesting, 4) End of the first anastomosis, 5) End of LIMA anastomosis, 6) 3-minutes after protamine administration, 7) End of the operation, and 8) Second hour in Intensive Care Unit (ICU), 9) Fifth hour in ICU. Mean Arterial Pressure (MAP) and Central Venous Pressure (CVP) were also recorded at the same time points as IOP.
Results
In Cardiopulmonary Bypass (CPB) groups (pulsatile or non-pulsatile CPB) with the beginning of CPB, there were significant decreases in IOP values when compared to baseline (p = 0.012). This decrease was more prominent in the non-pulsatile group when compared to the pulsatile group (T4 IOP values: pulsatile, 9.7 ± 2.6; non-pulsatile, 6.8 ± 1.9; p = 0.002; T5 IOP values: pulsatile, 9.5 ± 1.9; non-pulsatile, 6.7 ± 2.1; p = 0.004). At the end of the surgery (T7), IOP values returned to the baseline and stayed stable at the remaining time-points. In-off pump group, IOP values significantly increased with a head-down position (T4 IOP values: off-pump surgery, 19.7 ± 5.2; p = 0.015). IOP values remained high until the normalization of head-down position (T6) and stayed stable through the rest of all remaining time-points.
Conclusion
During cardiac surgery regardless of the technique (on-pump CABG, off-pump CABG), intraocular pressures remain in the normal ranges. It should be kept in mind that patients should be avoided from long and extreme Trendelenburg position, low CVP, and MAP levels during cardiac surgery to prevent eye-related complications.
Keywords
References
1 H. Hayashi, M. Kawaguchi, K. Hasuwa, et al. Changes in intraocular pressure during cardiac surgery with and without cardiopulmonary bypass J Anesth., 24 (2010), pp. 663-668
2 H. Bayram, D. Erer, E. Iriz, et al. Comparison of the effects of pulsatile cardiopulmonary bypass, non-pulsatile cardiopulmonary bypass and off-pump coronary artery bypass grafting on the inflammatory response and S-100 beta protein Perfusion., 27 (2012), pp. 56-64
3 H. Murgatroyd, J. Bembridge Intraocular pressure Continuing Education in Anaesthesia Crit Care Pain., 8 (2008), pp. 100-103
4 Y. Hoshikawa, N. Tsutsumi, K. Ohkoshi, et al. The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy Br J Ophthalmol., 98 (2014), pp. 305-308
5 O.J. Saeedi, J.L. Jefferys, J.F. Solus, et al. Risk factors for adverse consequences of low intraocular pressure after trabeculectomy J Glaucoma., 23 (2014), pp. e60-e68
6 A. Chhabra, S. Mishra, A. Kumar, et al. Atropine-induced lens extrusion in an open eye surgery Peadiatr Anaesth., 16 (2006), pp. 59-62
7 J. Kur, E.A. Newman, T. Chan-Ling Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease Prog Retin Eye Res., 31 (2012), pp. 377-406
8 D.F. Murphy Atracurium and intraocular pressure Anesth Analg., 64 (1985), pp. 520-530
9 G. Li, Y.Y. Shih, J.W. Kiel, et al. MRI study of cerebral, retinal, and choroidal blood flow responses to acute hypertension Exp Eye Res., 112 (2013), pp. 118-124
10 Y. Shiga, M. Shimura, T. Asano, et al. The influence of posture change on ocular blood flow in normal subjects, measured by laser speckle flowgraphy Curr Eye Res., 38 (2013), pp. 691-698
11 H. Bayram, D. Erer, E. Iriz, et al. Comparison of the effects of pulsatile cardiopulmonary bypass, non-pulsatile cardiopulmonary bypass and off-pump coronary artery bypass grafting on the respiratory system and serum carbonyl Perfusion., 27 (2012), pp. 378-385
12 M.A. Cheng, A. Todorov, R. Tempelhoff, et al. The effect of prone positioning on intraocular pressure in anesthetized patients Anesthesiology., 95 (2001), pp. 1351-1355
13 F. Nuhoglu, F. Gumus, S.N. Sinikoglu, et al. Changes in intraocular pressure during cardiopulmonary bypass International ophthalmology., 37 (2017), pp. 1155-1160
14 H. Awad, S. Santilli, M. Ohr, et al. The effects of steep Trendelenburg positioning on intraocular pressure during robotic radical prostatectomy Anesth Analg., 109 (2009), pp. 473-478
15 D.S. Rubin, M.M. Matsumoto, H.E. Moss, et al. Ischemic optic neuropathy in cardiac surgery incidence and risk factors in the United States from the National Inpatient Sample 1998 to 2013 Anesthesiology., 126 (2017), pp. 810-821
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