Effects of remifentanil on intraocular pressure during laparoscopic surgery in the steep trendelenburg position

Abstract

Abstract:

AIM: To observe the effects of remifentanil on intraocular pressure (IOP)undergoing laparoscopic gynecological surgery. METHODS: Ninety patients of ASA physical status ⅠorⅡ, were randomly allocated to 5 groups (n=18 each): low dose fentanyl group (group F1), high dose fentanyl group (group F2), low dose remifentanil group (group R1), medium dose remifentanil group (group R2) and high dose remifentanil group (group R3) . Upon pneumoperitoneum, Group F1, F2 received fentanil 2 or 4 mcg/kg intravenous bolus while Group R1, R2, R3 received intravenous loading dose of 1 mcg/kg followed by continuous infusions of remifentanil of 0.1, 0.2, or 0.4 μg·kg-1·min-1 till the end of the surgery. IOP, MAP, HR were recorded before (T0), 10 min(T1), 30 min(T2), 60 min(T3) and 90 min(T4) after onset of pneumoperitoneum and at 10 min(T5) after the end of pneumoperitoneum. Time to extubation after discontinue of anesthesia, incidence of intraocular hypertension (IOP>21 mm Hg), hypertension (SBP>140 mm Hg), hypotension(SBP<90 mm Hg), sinus tachycardia(HR>100 beat/min), sinus bradycardia (HR<60 beat/min) were recorded.RESULTS:Compared with T0 , IOP at T1-T5 in group F1, F2, R1, MAP at T1-T4 in group F1 and T1-T5 in group R1 were significantly increased while HR at T1-T5 in group F2、R3 were significantly lower (P'<0.01). Compared with group R2 and R3, IOP at T1-T4 in group F1, F2, R1, MAP and HR at T1-T5 in group F1, R1 were significantly increased (P'<0.01). The incidence of intraocular hypertension of group F1 , F2 and R1 was significantly higher than that of group R2 and R3（P''<0.005）. The incidence of hypertension and sinus tachycardia of group F1 and R1 were significantly higher than that of group F2, R2 and R3(P''<0.005).The incidence of sinus bradycardia of group R3 and extubation time of group F2 was significantly higher than that in the other 4 groups（P''<0.005,P<0.05）.CONCLUSION:Infusion of 0.2 μg·kg-1·min-1 of remifentanil can alleviate intraocular pressure elevation in patients undergoing gynecological laparoscopic surgery without worsen hemodynamic stability or delay the emergence of anesthesia.

Key words: laparoscopic surgery, remifentanil, intraocular pressure, complication

CLC Number:

R713

YU Liang, ZHOU Dachun, LIU Yang, GAO Bin. Effects of remifentanil on intraocular pressure during laparoscopic surgery in the steep trendelenburg position [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(9): 1062-1066.

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