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Effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing non-ophthalmic surgery

Published online by Cambridge University Press:  23 December 2004

S. M. Sator-Katzenschlager ,
M. J. Oehmke ,
E. Deusch ,
S. Dolezal ,
G. Heinze  and
A. Wedrich
S. M. Sator-Katzenschlager
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria University of Vienna, Department of Anaesthesiology and General Intensive Care (A), Vienna, Austria
M. J. Oehmke
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
E. Deusch
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
S. Dolezal
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (A), Vienna, Austria
G. Heinze
Affiliation:
University of Vienna, Department of Medical Computer Sciences, Vienna, Austria
A. Wedrich
Affiliation:
University of Vienna, Department of Ophthalmology and Optometrics, Vienna, Austria
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Abstract

Summary

Background and objective: To compare the effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing elective non-ophthalmic surgery.

Methods: Thirty-two patients (ASA I–II) were randomized into two groups to receive either a continuous infusion of remifentanil (0.25–0.5 μg kg−1 min−1, n = 16, Group R) or an intermittent bolus of fentanyl (2–5 μg kg−1, n = 16, Group F) during the maintenance of anaesthesia. For the induction of anaesthesia, Group R received remifentanil 1 μg kg−1 and Group F received fentanyl 2 μg kg−1; both groups then received propofol 2 mg kg−1 with vecuronium 0.1 mg kg−1. Anaesthesia in both groups was maintained with a continuous infusion of propofol 4–8 mg kg−1 h−1. Ventilation of the lungs was controlled to a constant end-tidal PCO2 of 4.7–5.4 kPa. Blood pressure, electrocardiography, heart rate and oxygen saturation were monitored throughout anaesthesia. Intraocular pressure was determined before surgery, during the maintenance of anaesthesia, 2 min after emergence and in the recovery room using a Perkins hand-held applanation tonometer by an ophthalmologist blinded to the anaesthetic technique.

Results: After induction of anaesthesia, a significant decrease in intraocular pressure in the remifentanil group from 13.6 ± 2.6 to 7.1 ± 3.1 mmHg (P < 0.001) and in the fentanyl group from 13.7 ± 2.2 to 9.7 ± 3.4 mmHg (P < 0.001) was observed and maintained during anaesthesia. Thirty minutes after the end of anaesthesia, intraocular pressure returned to baseline values in both groups (remifentanil: 13.9 ± 2.8 mmHg, P = 0.28; fentanyl: 13.6 ± 2.3 mmHg, P = 0.59). The intraocular pressure and haemodynamic variables did not differ significantly between the two groups (intraocular pressure, P = 0.7327; blood pressure, P = 0.1295; heart rate, P = 0.8601).

Conclusions: Remifentanil maintains intraocular pressure at an equally reduced level compared with fentanyl.

Keywords

ANALGESICS, OPIOID, fentanyl, remifentanilOCULAR PHYSIOLOGY, intraocular pressureSURGICAL PROCEDURES, OPERATIVE, intraoperative period, postoperative period
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 2 , February 2004 , pp. 95 - 100
Copyright
2004 European Society of Anaesthesiology

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