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Pupil changes during cardiopulmonary bypass

G C Fletcher1, A J Asbury, J H Brown

  • 1Department of Anaesthetics, Western Infirmary, Glasgow.

British Journal of Anaesthesia
|January 1, 1996
PubMed
Summary
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Cardiopulmonary bypass causes significant pupil dilation during anesthesia, regardless of fentanyl preloading. This effect persists post-bypass, suggesting other physiological factors influence pupil size.

Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Neuroscience

Background:

  • Pupil diameter is a critical indicator for assessing anesthetic depth and detecting cerebral hypoxia, particularly during cardiac bypass when other autonomic monitoring is limited.
  • Cardiopulmonary bypass (CPB) presents unique challenges for monitoring patient status due to altered physiological conditions.

Purpose of the Study:

  • To investigate the impact of cardiopulmonary bypass on pupil diameter.
  • To determine if fentanyl washout from the central nervous system contributes to changes in pupil size during CPB.

Main Methods:

  • A pupillometer was employed to measure pupil diameter in patients undergoing CPB.
  • Patients were divided into two groups: one with fentanyl preloaded into the bypass pump, and a control group with saline preloading.

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Main Results:

  • Cardiopulmonary bypass induced pupil dilatation ranging from 17% to 53%.
  • This pupil dilatation was not significantly affected by preloading the bypass pump with fentanyl.
  • The observed effect persisted for the study duration, ending 30 minutes after CPB initiation.

Conclusions:

  • Cardiopulmonary bypass demonstrably causes significant pupil dilatation.
  • Fentanyl preloading does not mitigate CPB-induced pupil dilatation, suggesting opioid washout is not the primary cause.
  • Further research is required to fully elucidate the mechanisms, potentially involving sympathetic nervous system reflexes and hypothermia, underlying CPB-induced pupillary changes.