SBU Gulhane School of Medicine Department of Cardiovascular Surgery, Ankara, Turkey.
SBU Ankara City Hospital Department of Cardiovascular Surgery, Ankara, Turkey.
Braz J Anesthesiol. 2021 Nov-Dec;71(6):612-617. doi: 10.1016/j.bjane.2021.01.001. Epub 2021 Feb 19.
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.
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.
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 (T IOP values: pulsatile, 9.7±2.6; non-pulsatile, 6.8±1.9; p=0.002; T IOP values: pulsatile, 9.5±1.9; non-pulsatile, 6.7±2.1; p=0.004). At the end of the surgery (T), 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 (T IOP values: off-pump surgery, 19.7±5.2; p=0.015). IOP values remained high until the normalization of head-down position (T) and stayed stable through the rest of all remaining time-points.
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.
本研究旨在探讨体外循环（CPB）下搏动性与非搏动性冠状动脉旁路移植术（CABG）及非体外循环下 CABG 对眼内压的影响。
纳入 45 例行择期 CABG 手术的患者，其中 CPB 下搏动性组（n=15）、CPB 下非搏动性组（n=15）和非 CPB 组（n=15）。在九个时间点对双眼进行眼内压（IOP）测量：1）手术前，2）麻醉诱导后，3）肝素给药后 3 分钟左乳内动脉（LIMA）采集，4）第一次吻合结束，5）LIMA 吻合结束，6）鱼精蛋白给药后 3 分钟，7）手术结束，8）重症监护病房（ICU）第 2 小时，9）ICU 第 5 小时。同时在相同时间点记录平均动脉压（MAP）和中心静脉压（CVP）。
在 CPB 组（搏动性或非搏动性 CPB）中，CPB 开始时，IOP 值与基线相比显著下降（p=0.012）。与搏动性 CPB 组相比，非搏动性 CPB 组下降更为明显（T IOP 值：搏动性组，9.7±2.6；非搏动性组，6.8±1.9；p=0.002；T IOP 值：搏动性组，9.5±1.9；非搏动性组，6.7±2.1；p=0.004）。手术结束时（T），IOP 值恢复到基线，其余时间点保持稳定。非 CPB 组中，头低位时 IOP 值显著升高（T IOP 值：非 CPB 手术，19.7±5.2；p=0.015）。IOP 值在头低位恢复正常后仍保持高位（T），并在其余所有时间点保持稳定。
无论采用何种手术技术（CPB 下 CABG、非 CPB 下 CABG），眼内压均保持在正常范围内。在心脏手术过程中，应注意避免患者长时间处于极端的头低位、低中心静脉压和低平均动脉压，以预防与眼相关的并发症。
