Effects Of Different Doses Of Remifentanil On Intraocular Pressure In Patients Undergoing Laparoscopic Gynecological Surgery

Objective:To observe the effects of different doses of remifentanil on intraocular pressure(IOP)in patients undergoing laparoscopic gynecological surgery.Methods:Sixty patients with ASA Ⅰ～Ⅱ scheduled for laparoscopic gynecological surgery were randomly assigned to 4 groups:GroupF(N=15),R1(N=15),R2(N=15),R3(N=15).Group F received fentanil 2μg/kg intravenous bolus injection before pneumoperitoneum.Group R1,R2,R3 received a continuous infusion of remifentanil of 0.1,0.2,or 0.4μg/kg/min starting before pneumoperitoneum till the end of the surgery.IOP,MAP,HR,BIS were measured and recorded before pneumoperitoneum(TO),at 10 min(T1),30 min(T2),60 min(T3)and 90 min(T4)after pneumoperitoneum,and at 10 min(T5)after the end of pneumoperitoneum.Results:Patients’ characteristics were not significantly different among the four groups.There were no significant differences in patients’ IOP values at TO in the four groups.In group F,the IOP was increased at T1、T2、T3、T4、T5[(15.83±2.88)mmHg、(17.82±3.00)mmHg、(18.54±3.21)mmHg、(19.63±2.68)mmHg和 (15.11±2.83)mmHg]comparing to TO[(10.741±1.85)mmHg](P<0.05).The IOP in the group R2 and R3 at T1、T2、T3、T4 and T5[(11.59±1.78)mmHg、(12.2±1.56)mmHg、(11.81±1.17)mmHg、(13.37 ±1.96)mmHg、(12.01±1.12)mmHg、(12.49±1.52)mmHg、(13.34±1.75)mmHg、(12.6±1.12)mmHg、(12.76±1.29)mmHg、(12.96±1.74)mmHg]were significantly decreased than those of group F[(15.83±2.88)mmHg、(17.82±3.00)mmHg、(18.54±3.21)mmHg、(19.63±2.68)mmHg、(15.11±2.83)mmHg](P<0.05).Comparing between group F and R1,the IOP at each time point were not significant different(P>0.05).Comparing between group R2 and R3,the IOP at each time point were also not significantly different(P>0.05).There were no significant differences in patients’ MAP at TO in the four groups(P>0.05).In group F,the MAP was higher at T1、T2、T3、T4comparing to TO(P<0.05).Comparing between group F and R1,the MAP at each time point were not significant different(P>0.05).The MAP in the group R2 and R3 at T1、T2、T3 and T4 were significantly lower than those of group F(P<0.05).The MAP in group R3 at T1、T3、T4、T5 were lower than these in group R2(P<0.05).There were no significant differences in patients’ HR at TO in the four groups(P>0.05).In group F,the HR was increased at T1、T2、T3、T4comparing to TO(P<0.05),while T5 was not significant different comparing to TO(P>0.05).Comparing between group F and R1,the HR at T2、T3、T4 were not significant different(P>0.05).The HR in the group R2 and R3 at T1、T2、T3、T4 and T5were significantly lower than those of group F(P<0.05).The HR in group R3 at T1、T3、T5 were lower than these in group R2(P<0.05).The incidence of intraocular hypertension,hypertension and sinus tachycardia of group F and Rl were significantly higher than that of group R2 and R3(P<0.05).The incidence of sinus bradycardia of group R3(93.33%)and was significantly higher than that in the other three groups[groupF(0%)、group R1(%)和 group R2(20%)](P<0.05).Conclusions:Compared with infusion of fentanyl 2 μg/kg before artificial pneumoperitoneum immediately,infusion of 0.2,0.4μg/kg/min of remifentanil can alleviate intraocular pressure elevation in patients undergoing gynecological laparoscopic surgery.Comparing between group R2(0.2μg/kg/min)and R3(0.4μg/kg/min),the IOP at each time point were no significant differences(P>0.05).Compared to the other three groups,the incidence of perioperative complications was lower in group R2 and therefore the application of 0.2μg/kg/min of remifentanil is more suitable for clinical anesthesia.