This journal is
indexed in Scopus
Year 2018 Vol. 26 No 1
D.A. SHKURUPII, M.Î. HARKAVENKO, D.A. KHOLOD
OPHTHALMOLOGICAL COMPLICATIONS OF GENERAL ANESTHESIA
Ukrainian Medical Stomatological Academy, Poltava,
Objective. To determine the frequency and nature of ophthalmic disorders, depending on the use of general anesthesia means.
Methods. A prospective cohort non-interventional study was organized, in which 100 patients were included. A comparison was made of the nature of the disturbances of the visual organ, depending on the type of general anesthesia performed. Clinical examinations included standard perioperative monitoring, determination of the type and nature of pharmacological support for anesthesia, perioperative assessment of saturation, noninvasive blood pressure with determination of its systolic, diastolic and perfusion components, ophthalmologic examination, ocular tonometry, quality assessment of tear film, volume of basal secretion of tear, visual acuity, color sensation, peripheral and binocular vision.
Results. The incidence of disturbances of the visual organ and the visual analyzer after general anesthesia was 19% (n=19). Of them, 84.2% (n=16) of patients had several ophthalmic disorders. The relationship between changes in the arterial pressure figures and the frequency of ophthalmic disorders was established. At the same time, the development of ophthalmic disorders was mainly associated with a change in perfusion blood pressure (p = 0.02). The character of these changes depended on the use of a certain anesthetic. Thus, the drugs of the hypnotic group (thiopental sodium, propofol) reduced the ophthalmotonus, tear secretion, tear film resistance, visual acuity. These effects were more pronounced in thiopental sodium. Also, the ability of ketamine to increase the ophthalmotonus, to cause lacrimation and to disturb visual perception due to disorder of peripheral and binocular vision was proved. Ophthalmic disorders resulted from the use of sedatives (diazepam) and narcotic analgesics (fentanyl) were not proven.
Conclusions. Disturbances of the visual organ and visual analyzer after general anesthesia are transient and account for 19%, of which 84.2% of cases are combined ophthalmic disorders. Their occurrence depends on the arterial pressure figures and the pharmacological effect of the anesthetics used.
- Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010 Jun 24;4:531-46.
- Marcucci C, Cohen NA, Metro DG, Kirsch JR, editors. Avoiding Common Anesthesia Errors. Philadelphia PA, USA: Lippincott Williams & Wilkins; 2008. 1030 p.
- Anson J. Perioperative Corneal Abrasions: Etiology, Prevention, and Management [Electronic resource]. Available from: http://www.psanes.org/Anesthesiologists/ClinicalResources/ClinicalUpdates/tabid/94/anid/29/Default.aspx.
- Kocatürk ö, Kocatürk T, Kaan N, Dayanir V. The comparison of four different methods of perioperative eye protection under general anesthesia in prone position. J Clin Anal Med. 2012;3(2):163-65. doi: 10.4328/JCAM.607.
- Nair PN, White E. Care of the eye during anaesthesia and intensive care. Anaesth Intens Care. 2014 Jan;15(Is1):40-43. doi: 10.1016/j.mpaic.2013.11.008.
- Zheng K, Guta CG, Kulkarni V, Brock-Utne J. Prevention of corneal abrasions in patients with autoimmune dry eyes. Anesth Analg. 2009 Jan;108(1):385-86. doi: 10.1213/ane.0b013e31818c8fd7.
- Grixti A, Sadri M, Watts MT. Corneal protection during general anesthesia for nonocular surgery. Ocul Surf. 2013 Apr;11(2):109-18. doi: 10.1016/j.jtos.2012.10.003.
- White L. Section 5: Damage to the eye during general anaesthesia. Risks associated with your anaesthetic [Electronic resource]. London, UK: RCoA; 2017. 6 p. Available from: https://www.rcoa.ac.uk/system/files/05-DamageEye2017.pdf.
- Bansal S, Ansons A, Vishwanath M. Hypotension-induced blindness in haemodialysis patients. Clin Kidney J. 2014 Aug;7(4):387-90. doi: 10.1093/ckj/sfu036.
- Avetisov SE, Egorov EA, Moshetova LK, Neroev VV, Takhchidi KhP, red. Oftal’mologiia: nats ruk. Moscow, RF: GEOTAR-Media; 2013. 944 p. (in Russ.)
- Pontes KC de S, Borges APB, Eleotério RB, Ferreira PS, Duarte ÒS. Comparação da produção lacrimal em cães após indução anestésica com propofol e thiopental. Revista Ceres. 2010;57(6):757-61.
- Nair G, Kim M, Nagaoka T, Olson DE, Thulé PM, Pardue MT, Duong TQ. Effects of common anesthetics on eye movement and electroretinogram. Doc Ophthalmol. 2011 Jun;122(3):163-76. doi: 10.1007/s10633-011-9271-4.
- Schmechtig A, Lees J, Perkins A, Altavilla A, Craig KJ, Dawson GR, William Deakin JF, Dourish CT, Evans LH, Koychev I, Weaver K, Smallman R, Walters J, Wilkinson LS, Morris R, Williams SC, Ettinger U. The effects of ketamine and risperidone on eye movement control in healthy volunteers. Transl Psychiatry. 2013 Dec 10;3:e334. doi: 10.1038/tp.2013.109.
- Bunch TJ, Tian B, Seeman JL, Gabelt BT, Lin TL, Kaufman PL. Effect of daily prolonged ketamine anesthesia on intraocular pressure in monkeys. Curr Eye Res. 2008 Nov;33(11):946-53. doi: 10.1080/02713680802447121.
Poltava, Shevchenko Str., 23,
Ukrainian Medical Stomatological Academy,
Department of Anesthesiology
with Intensive Therapy
Tel: +380 532 60-95-81,
Shkurupii Dmytro A.
Shkurupii Dmytro A., MD, Associate Professor of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
Harkavenko Maxim A., Applicant for Master’s Degree of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
Kholod Dmytro A., Post-Graduate Student of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.