Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-19T07:57:50.299Z Has data issue: false hasContentIssue false
  • English
  • Français

Abnormalities of contrast sensitivity and electroretinogram following sevoflurane anaesthesia

Published online by Cambridge University Press:  23 December 2004

G. Iohom ,
C. Gardiner ,
A. Whyte ,
G. O'Connor  and
G. Shorten
G. Iohom
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
C. Gardiner
Affiliation:
Cork University Hospital, Department of Ophthalmology, Cork, Ireland
A. Whyte
Affiliation:
Cork University Hospital, Department of Ophthalmology, Cork, Ireland
G. O'Connor
Affiliation:
Cork University Hospital, Department of Ophthalmology, Cork, Ireland
G. Shorten
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
Get access

Abstract

Summary

Background and objective: We tested the hypothesis that disturbances of the visual pathway following sevoflurane general anaesthesia (a) exist and persist even after clinical discharge criteria have been met and (b) are associated with decreased contrast sensitivity.

Methods: We performed pattern and full-field flash electroretinograms (ERG) in 10 unpremedicated ASA I patients who underwent nitrous oxide/sevoflurane anaesthesia. ERG and contrast sensitivity were recorded preoperatively, immediately after discharge from the recovery room and 2 h after discontinuation of sevoflurane. The time at which the Post Anaesthesia Discharge Score first exceeded 9 was also noted. Data were analysed using paired, one-tailed t-tests and Pearson's correlation coefficient.

Results: On the full-field photopic ERG, b-wave latency was greater at each postoperative time point (31.6 ± 1.1 and 30.8 ± 1.1 ms) compared to preoperatively (30.1 ± 1.1 ms, P < 0.001 and P = 0.03, respectively). Oscillatory potential latencies were greater on discharge from the recovery room compared with pre-anaesthetic values (23.1 ± 3.1 vs. 22.4 ± 3.3 ms, P = 0.01) and returned to baseline by 2 h after emergence from anaesthesia. Also at 2 h after emergence from anaesthesia: (a) P50 latency on the pattern ERG was greater than at baseline (81.5 ± 17.9 vs. 51.15 ± 22.6 ms, P = 0.004); (b) N95 amplitude was less compared to pre-anaesthetic values (2.6 ± 0.5 vs. 3.3 ± 0.4 μV, P = 0.003) and (c) contrast sensitivity was less compared to baseline values (349 ± 153 vs. 404 ± 140, P = 0.048). A positive correlation was demonstrated between contrast sensitivity and both N95 amplitude and b-wave latency (r = 0.99 and r = −0.55 at significance levels of P < 0.005 and P < 0.05, respectively).

Conclusions: Postoperative ERG abnormalities and associated decreases in contrast sensitivity are consistently present in patients who have undergone nitrous oxide/sevoflurane anaesthesia. These abnormalities persist beyond the time at which standard clinical discharge criteria have been met.

Keywords

ANAESTHESIAANAESTHETICS INHALATIONAL, sevoflurane, nitrous oxideANAESTHESIA RECOVERY PERIODDIAGNOSTIC TECHNIQUES, ophthalmological, electroretinography, contrast sensitivity
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 646 - 652
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Troy AM, Cunnigham AJ. Ambulatory surgery: an overview. Curr Opin Anaesthesiol 2002; 15: 647–657.Google Scholar
Iohom G, Collins I, Murphy D, et al. Postoperative changes in visual evoked potentials and cognitive function tests following sevoflurane anaesthesia. Br J Anaesth 2001; 87: 855–859.Google Scholar
Iohom G, Whyte A, Flynn T, O'Connor G, Shorten G. Postoperative changes in full field electroretinogram following sevoflurane anaesthesia.Eur J Anaesthesiol (in press).
Enz R, Cutting GR. Molecular composition of GABAC receptors. Vision Res 1998; 38: 1431–1441.Google Scholar
Marmor MF, Arden GB, Nilsson SE, Zrenner E. Standard for clinical electroretinography. Arch Ophthalmol 1989; 107: 816–819.Google Scholar
Marmor MF, Zrenner E. Standard for clinical electroretinography (1999 update). International Society for Clinical Electrophysiology of Vision. Doc Ophthalmol 1999; 97: 143–156.Google Scholar
Della Sala S, Somazzi L, Wilkins AJ. Rapid technique for detecting ‘blurred vision’ in diseases of primary visual pathways. Lancet 1985; 2: 1015–1016.Google Scholar
Bond A, Lader M. The use of analogue scales in rating subjective feelings. Br J Med Psychol 1974; 47: 211–218.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.Google Scholar
Aldrete JA. The postanesthesia recovery score revisited. J Clin Anesth 1995; 7: 89–91.Google Scholar
Chung F. Recovery pattern and home-readiness after ambulatory surgery. Anesth Analg 1995; 80: 896–902.Google Scholar
Marshall S, Chung F. Assessment of ‘home readiness’: discharge criteria and postdischarge complications. Curr Opin Anaesthesiol 1997; 10: 445–450.Google Scholar
Karwosky C. Introduction to the origins of electroretinographic components. In: Hackenlively JR, Arden GB, eds. Principle and Practice of Clinical Electrophysiology of Vision. St Louis, USA: Mosby-Year Book, 1991: 87–91.
Ikeda H. Clinical electroretinography. In: Halliday AM, ed. Evoked Potentials in Clinical Testing. London, UK: Churchill Livingstone, 1982: 121–148.
Tashiro C, Murashini R, Gomyo I, Mashimo T, Tomi K, Yoshiya I. Electroretinogram as a possible monitor of anesthetic depth. Graefes Arch Clin Exp Ophthalmol 1986; 224: 473–476.Google Scholar
O'Donoghue E, Arden GB, O'Sullivan F, et al. The pattern electroretinogram in glaucoma and ocular hypertension. Br J Ophthalmol 1992; 76: 387–394.Google Scholar
Sieving PA, Steinberg RH. Contribution from proximal retina to intraretinal pattern ERG: the M-wave. Invest Ophthalmol Vis Sci 1985; 26: 1642–1647.Google Scholar
Sieving PA, Steinberg RH. Proximal retinal contribution to the intraretinal 8-Hz pattern ERG of cat. J Neurophysiol 1987; 57: 104–120.Google Scholar
Berninger T, Schuurmans RP. Spatial tuning of the pattern ERG across temporal frequency. Doc Ophthalmol 1985; 61: 17–25.Google Scholar
Schuurmans RP, Berninger T. Luminance and contrast responses recorded in man and cat. Doc Ophthalmol 1985; 59: 187–197.Google Scholar
Wellis PD, Werblin FS. Dopamine modulates GABAc receptors mediating inhibition of calcium entry onto transmitter release from bipolar cell terminals in tiger salamanders. J Neurosci 1995; 15: 4748–4761.Google Scholar
Vaegan, Halliday BL. A forced-choice test improves clinical contrast sensitivity testing. Br J Ophthalmol 1982; 66: 477–491.Google Scholar
Higgins KE, Jaffe MJ, Coletta NJ, Caruso RC, de Monasterio FM. Spatial contrast sensitivity. Importance of controlling the patient's visibility criterion. Arch Ophthalmol 1984; 102: 1035–1041.Google Scholar
Wilkins AJ, Della Sala S, Somazzi L, Nimmo-Smith I. Age-related norms for the Cambridge Low Contrast Gratings, including details concerning their design and use. Clin Vision Sci 1988; 3: 201–212.Google Scholar
Della Sala S, Bertoni G, Somazzi L, Stubbe F, Wilkins AJ. Impaired contrast sensitivity in diabetic patients with and without retinopathy: a new technique for rapid assessment. Br J Ophthalmol 1985; 69: 136–142.Google Scholar
Wasserschaff M, Schmidt JG. Electroretinographic responses to the addition of nitrous oxide to halothane in rats. Doc Ophthalmol 1986; 64: 347–354.Google Scholar