Effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing non-ophthalmic surgery
Sator-Katzenschlager, S.M.; Oehmke, M.J.; Deusch, E.; Dolezal, S.; Heinze, G.; Wedrich, A.
European Journal of Anaesthesiology 21(2): 95-100
2004
ISSN/ISBN: 0265-0215 PMID: 14977339 Document Number: 574920
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 mug kg-1, min-1, n=16, Group R) or an intermittent bolus of fentanyl (2-5 mug kg-1, n=16, Group F) during the maintenance of anaesthesia. For the induction of anaesthesia, Group R received remifentanil 1 mug kg-1 and Group F received fentanyl 2 mug 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.