Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

Battu, Rajani; Prasad, Apoorva; Kanchi, Muralidhar

doi:10.4103/0971-9784.129823

Cited by 5 publications

(4 citation statements)

References 19 publications

(49 reference statements)

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“…In a study of 1,442 patients who underwent OPCABG, PION was identified in four diabetic patients. [ 7 ] There was a statistically significant drop in hematocrit and mean arterial blood pressure in the postoperative period compared to pre-operative values for these patients. These observations highlight the importance of monitoring and managing factors such as CPB time, hematocrit levels, body weight gain, and anesthesia-related medications to minimize the risk of ION in cardiac surgical procedures, particularly in diabetic patients.…”

Section: Discussionmentioning

confidence: 90%

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Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Gupta,

Singla,

Gupta

et al. 2024

Annals of Cardiac Anaesthesia

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Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross-clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro-embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro-embolization, inflammation, hemodilution, and hypothermia. While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.

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Section: Discussionmentioning

confidence: 90%

“…All patients had diabetes, and peri-operative hematocrit decrease and systemic hypotension were significant risk factors. [ 7 ]…”

Section: Resultsmentioning

confidence: 99%

Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Gupta,

Singla,

Gupta

et al. 2024

Annals of Cardiac Anaesthesia

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“…OPCABG is a form of CABG surgery. According to statistics, due to its hemodynamic abnormalities during surgery [19], only about 20% of CABG surgeries are now performed under nonextracorporeal circulation. OPCABG has exhibited some advantages, especially in reducing postoperative complications such as systemic inflammation and myocardial and cerebral damage [20,21].…”

Section: Discussionmentioning

confidence: 99%

Functional Modular Network Identifies the Key Genes of Preoperative Inhalation Anesthesia and Intravenous Anesthesia in Off-Pump Coronary Artery Bypass Grafting

Zhao

Wang

Liu

et al. 2020

Computational and Mathematical Methods in Medicine

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Off-pump coronary artery bypass grafting (OPCABG) is an effective strategy for revascularization. Preoperative anesthesia appears critical due to surgical instability and the risk of organ damage. This study, based on a functional module network, analysed the effects of preoperative inhalation anesthesia and intravenous anesthesia on OPCABG and performed a pivot analysis of its potential drug regulators. We obtained microarray data of sevoflurane anesthesia and propofol anesthesia from the GEO database and analysed the difference between the two groups of data, resulting in 5701 and 3210 differential genes to construct the expression matrix. WGCNA analysis showed that sevoflurane anesthesia clustered into 7 functional disorder modules, including PDCD6IP, WDR3, and other core genes; propofol anesthesia clustered to form two functional disorder modules, including KCNB2 and LHX2, two core genes Enrichment analysis of the functions and pathways of interest suggests that both anesthesia-related module genes tend to function as pathways associated with ion and transmembrane transport. The underlying mechanism may be that targeted regulation of transmembrane-associated biological processes and ion pathways in the core genes of each module affect the surgical process. Pivot analysis of potential drug regulators revealed 229 potential drugs for sevoflurane anesthesia surgery, among which zinc regulates three functional disorder modules via AHSG, F12, etc., and 67 potential drugs for propofol anesthesia surgery, among which are propofol, methadone, and buprenorphine, regulate two functional disorder modules through four genes, CYP2C8, OPRM1, CYP2C18, and CYP2C19. This study provides guidance on clinical use or treatment by comparing the effects of two anesthesias on surgery and its potential drugs.

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“…[19] All patients were male, over 50 years of age, and known diabetics on treatment, which was well-controlled prior to surgery. Of four patients, one had lost vision two years ago in one eye due to diabetes-related complications; one patient had mild nonproliferative diabetic retinopathy in both eyes, and the remaining two patients had no evidence of diabetic retinopathy.…”

Section: Postoperative Vision Loss During Off-pump Coronary Artery Bymentioning

confidence: 99%

Postoperative vision loss during off-pump coronary artery bypass grafting

Neema

2014

Ann Card Anaesth

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Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

Abstract: PON is a rare but definite possibility in patients undergoing OPCABG. Diabetes mellitus may be a risk factor. Perioperative hemodynamic abnormalities like decrease in MAP and anemia may play a role in the development of PON in OPCABG.

Cited by 5 publications

References 19 publications

Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Functional Modular Network Identifies the Key Genes of Preoperative Inhalation Anesthesia and Intravenous Anesthesia in Off-Pump Coronary Artery Bypass Grafting

Postoperative vision loss during off-pump coronary artery bypass grafting

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