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Abstract #25374 Published in IGR 12-1
Evaluation of related factors associated with a severe reduction in intraocular pressure during cardiovascular surgery with cardiopulmonary bypass
Hasuwa K; Hayashi H; Kawaguchi M; Yoshitani K; Furuya HJournal of Neurosurgical-Anesthesiology 2009; 21: 417-418
Introduction: Postoperative ophthalmological complication is a rare, but devastating complication after cardiac surgery. The etiology of ophthalmological complication after cardiac surgery remained undetermined. However, the changes in intraocular pressure (IOP) may be related to the development of postoperative ophthalmological complication. Recently, we reported that the induction of cardiopulmonary bypass (CPB) caused a significant fall of IOP during cardiovascular surgery. It is however unknown which parameters are mainly related to a reduction in IOP during CPB. The present study was conducted to investigate the related factors associated with a severe reduction in IOP during CPB. Methods: After institutional approval and written informed consent were obtained, 41 patients undergoing cardiovasucular surgery with CPB were enrolled in the study. Patients with preoperative glaucoma and those who underwent intraoperative deep hypothermic circulatory arrest and selective cerebral perfusion were precluded. All patients were divided into 2 groups according to the degree of IOP reduction during CPB: the mild reduction group (M group) or severe reduction group (S group). In the M group, the lowest IOP values were more than or equal to 5 mm Hg, whereas those less than 5 mm Hg in the S group. Anesthesia was maintained with propofol, fentanyl and vecuronium or rocuronium during CPB. Bilateral IOPs were measured using the Tonopen handheld tonometer (Tonopen XL, BIO RAD, Osaka) after the induction of anesthesia, 60 minutes after the beginning of CPB and at the end of operation. Demographic variables including age, sex, height, weight, body mass index (BMI), patient history of illness, and medication, and intraoperative variables including the type of operation, mean arterial pressure, central venous pressure (CVP), body temperature (BT), blood gas data, regional cerebral oxygen saturation (rSO2), and pump flow during CPB were recorded. These variables were compared between the two groups using the unpaired t test or chi-squire test and logistic regression analysis. Results: After the induction of anesthesia, there wsa no significant difference in IOP values between the groups. Seventeen patients were included in the M group, whereas 24 patients in the S group. IOP values (mean +/- SD) 60 minutes after the beginning of CPB were 9.9 +/- 0.9 and 3.2+/-0.1 in the M and S group, respectively. The values of weight, BMI, CVP, BT, right rSO2, pump flow in the S group were significantly lower than those in the M group. In the M group, significantly more patients who underwent coronary artery bypass surgery without the cardiac arrest (on pump beating) were included compared with those in the S group. Multivariate logistic regression analysis revealed that a reduction of BT (less than 32.0 degrees C) and pump flow rates (less than 2.5 L/min/m(2)) had significant assciations with the severe reduction of IOP during CPB (BT; odd ratio 6.5, 95% confident interval 11.1-38.0, pump flow rates; odd ratio 5.7, 95% confident interval 1.2-27.6). Conclusion: The results in the present study indicated that low BT and pump flow rates may be associated with the severe reduction of IOP during CPB.
K. Hasuwa. Department of Anesthesiology, Nara Medical University, .
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
6.11 Bloodflow measurements (Part of: 6 Clinical examination methods)
