JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Nuttall, G. A. Articles by Mullany, C. J. Search for Related Content PubMed PubMed Citation Articles by Nuttall, G. A. Articles by Mullany, C. J. Related Collections Cardiovascular Heart Monitoring (Cardiac)

---

CARDIOVASCULAR ANESTHESIA

Risk Factors for Ischemic Optic Neuropathy After Cardiopulmonary Bypass: A Matched Case/Control Study

Gregory A. Nuttall, MD^*, James A. Garrity, MD, Joseph A. Dearani, MD, Martin D. Abel, MD^*, Darrell R. Schroeder, MS, and Charles J. Mullany, MB MS

Departments of *Anesthesiology, Ophthalmology, and Surgery, Mayo Graduate School of Medicine, Rochester, Minnesota; and Department of Biostatistics, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Gregory A. Nuttall, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Address e-mail to nuttall.gregory{at}mayo.edu

Visual loss (acuity or field) secondary to ischemic optic neuropathy (ION) is a rare but devastating complication of cardiac surgery involving cardiopulmonary bypass (CPB). We determined clinical features and risk factors for ION by a retrospective time-matched, case-control study. ION was identified in 17 (0.06%) patients out of 27,915 patients who underwent CPB between January 1, 1976, and December 31, 1994. For each ION patient, two patients who underwent CPB exactly 2 wk before the ION patient were selected as controls. Data were analyzed by using conditional logistic regression with the 1:2 matched-set feature of 17 cases and 34 controls. Two-tailed P values 0.05 were considered significant. From bivariate analysis, smaller minimum postoperative hemoglobin concentration (odds ratio [OR] = 1.9, P = 0.047) and the presence of atherosclerotic vascular disease (OR = 7.0, P = 0.026) were found to be independently associated with ION after CPB, as were smaller minimum postoperative hemoglobin concentration (OR = 2.2, P = 0.027) and preoperative angiogram within 48 h of surgery (OR = 7.2, P = 0.042). In ION patients, 13 (76.5%) of 17 experienced a minimum postoperative hemoglobin value of <8.5 g/dL, whereas only 14 (41.2%) of 34 control patients experienced values <8.5 g/dL.

IMPLICATIONS: Patients with clinically significant vascular disease history or preoperative angiogram may be at increased risk for ischemic optic neuropathy after cardiac surgery, especially if the hemoglobin remains low in the postoperative period.

This article has been cited by other articles:

				B. D. Spiess Transfusion of Blood Products Affects Outcome in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 267 - 281. [Abstract] [PDF]

				H. P. Grocott, J. A. Clark, H. M. Homi, and A. Sharma "Other" Neurologic Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 213 - 226. [Abstract] [PDF]

				S. D. Kalyani, N. R. Miller, L. M. Dong, W. A. Baumgartner, D. E. Alejo, and T. B. Gilbert Incidence of and risk factors for perioperative optic neuropathy after cardiac surgery Ann. Thorac. Surg., July 1, 2004; 78(1): 34 - 37. [Abstract] [Full Text] [PDF]

				M. T. Bhatti and F. K. Enneking Visual Loss and Ophthalmoplegia After Shoulder Surgery Anesth. Analg., March 1, 2003; 96(3): 899 - 902. [Abstract] [Full Text] [PDF]

				M. E. Warner, M. A. Warner, J. A. Garrity, R. A. MacKenzie, and D. O. Warner The Frequency of Perioperative Vision Loss Anesth. Analg., December 1, 2001; 93(6): 1417 - 1421. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999