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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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References

Jantzen JP. Anaesthesia and intraocular pressure. Anaesthesist 1998; 37: 458–469.Google Scholar
Artru AA. Trabecular outflow facility and formation rate of aqueous humor during propofol, nitrous oxide, and halothane anesthesia in rabbits. Anesth Analg 1993; 77: 564–569.Google Scholar
Donlon JV Jr. Anesthesia for eye, ear, nose and throat surgery. In: Miller RD, ed. Anesthesia, 5th edn. New York, USA: Churchill Livingstone, 2000: 2173–2198.
Coupland SG, Deschenes MC, Hamilton RC. Impairment of ocular blood flow during regional orbital anesthesia. Can J Ophthalmol 2001; 36: 140–144.Google Scholar
Findl O, Dallinger S, Menapace R, et al. Effects of peribulbar anesthesia on ocular blood flow in patients undergoing cataract surgery. Am J Ophthalmol 1999; 127: 645–649.Google Scholar
Sator-Katzenschlager SM, Oehmke MJ, Kontaratos M, Wedrich A, Heinze G, Weinstabl C. Effect of different doses of cisatracurium on intraocular pressure in sedated patients. Eur J Anaesthesiol 2002; 19: 823–828.Google Scholar
Lauwers M, Camu F, Vanlersberghe C. Remifentanil, an esterase metabolised opioid: What advantages does it offer in analgesia and anaesthesia? CNS Drugs 1997; 8: 189–198.Google Scholar
Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999; 89 (Suppl): 7S–14.Google Scholar
SAS Institute, Inc. SAS/STAT User's Guide, Version 8. Cary, NC, USA: SAS Institute, Inc., 1999: 1562.
Perkins ES. Hand-held applanation tonometer. Br J Ophthalmol 1965; 49: 591–593.Google Scholar
Dunn JS, Brubaker RF. Perkins applanation tonometer. Clinical and laboratory evaluation. Arch Ophthalmol 1973; 89: 149–151.Google Scholar
Sator S, Wildling E, Schabernig C, Akramian J, Zulus E, Winkler M. Desflurane maintains intraocular pressure at an equivalent level to isoflurane and propofol during unstressed non-ophthalmic surgery. Br J Anaesth 1998; 80: 243–244.Google Scholar
Schäfer R, Klett J, Auffarth G, et al. Intraocular pressure more reduced during anesthesia with propofol than with sevoflurane: both combined with remifentanil. Acta Anaesthesiol Scand 2002; 46: 703–706.Google Scholar
Alexander R, Hill R, Lipham WJ, Weatherwax KJ, el-Moalem HE. Remifentanil prevents an increase in intraocular pressure after succinylcholine and tracheal intubation. Br J Anaesth 1998; 81: 606–607.Google Scholar
Ng HP, Chen FG, Yeong SM, Wong E, Chew P. Effect of remifentanil compared with fentanyl on intraocular pressure after succinylcholine and tracheal intubation. Br J Anaesth 2000; 85: 785–787.Google Scholar
Cunningham AJ, Barry P. Intraocular pressure – physiology and implications for anaesthetic management. Can Anaesth Soc J 1986; 33: 195–208.Google Scholar
Minkowitz HS. Postoperative pain management in patients undergoing major surgery after remifentanil vs. fentanyl anesthesia. Multicentre Investigator Group. Can J Anesth 2000; 47: 522–528.Google Scholar
Bekker AY, Berklayd P, Osborn I, Bloom M, Yarmush J, Turndorf H. The recovery of cognitive function after remifentanil–nitrous oxide anesthesia is faster than after an isoflurane–nitrous oxide–fentanyl combination in elderly patients. Anesth Analg 2000; 91: 117–122.Google Scholar
Tramèr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth 1997; 78: 247–255.Google Scholar