瑞芬太尼和芬太尼对非眼科手术患者麻醉维持和苏醒期间眼压的影响。

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

作者信息

Sator-Katzenschlager S M, Oehmke M J, Deusch E, Dolezal S, Heinze G, Wedrich A

机构信息

University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria.

出版信息

Eur J Anaesthesiol. 2004 Feb;21(2):95-100. doi: 10.1017/s0265021504002030.

DOI:10.1017/s0265021504002030

PMID:14977339

Abstract

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 microg kg(-1) min(-1), n =16, Group R) or an intermittent bolus of fentanyl (2-5 microg kg(-1), n = 16, Group F) during the maintenance of anaesthesia. For the induction of anaesthesia, Group R received remifentanil 1 microg kg(-1) and Group F received fentanyl 2 microg 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.

摘要

背景与目的

比较瑞芬太尼和芬太尼对择期非眼科手术患者麻醉维持期及苏醒期眼压的影响。

方法

32例美国麻醉医师协会（ASA）分级为I-II级的患者被随机分为两组，在麻醉维持期分别持续输注瑞芬太尼（0.25 - 0.5微克/千克·分钟，n = 16，R组）或间断推注芬太尼（2 - 5微克/千克，n = 16，F组）。麻醉诱导时，R组给予瑞芬太尼1微克/千克，F组给予芬太尼2微克/千克；两组随后均给予丙泊酚2毫克/千克和维库溴铵0.1毫克/千克。两组均通过持续输注丙泊酚4 - 8毫克/千克·小时维持麻醉。控制肺通气使呼气末二氧化碳分压恒定在4.7 - 5.4千帕。整个麻醉过程中监测血压、心电图、心率和血氧饱和度。术前、麻醉维持期、苏醒后2分钟及在恢复室，由对麻醉技术不知情的眼科医生使用珀金手持式压平眼压计测定眼压。

结果

麻醉诱导后，观察到瑞芬太尼组眼压从13.6±2.6毫米汞柱显著降至7.1±3.1毫米汞柱（P < 0.001），芬太尼组眼压从13.7±2.2毫米汞柱显著降至9.7±3.4毫米汞柱（P < 0.001），且在麻醉期间维持该水平。麻醉结束30分钟后，两组眼压均恢复至基线值（瑞芬太尼组：13.9±2.8毫米汞柱，P = 0.28；芬太尼组：13.6±2.3毫米汞柱，P = 0.59）。两组间眼压及血流动力学变量无显著差异（眼压，P = 0.7327；血压，P = 0.1295；心率，P = 0.8601）。