Document Detail

The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure.
MedLine Citation:
PMID:  20868965     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To evaluate the effect of propofol (two mg/kg)/remifentanil (4 μg/kg) on intraocular pressure (IOP) when used for rapid-sequence induction.
DESIGN: Randomized, double-blinded trial.
SETTING: Ambulatory surgery center.
PATIENTS: 47 adult, ASA physical status I and II patients (ages 18-75 yrs), undergoing outpatient, elective, nonophthalmologic surgery.
INTERVENTIONS: After premedication with midazolam (two mg) and glycopyrrolate (0.2 mg), standard monitors and a bispectral index (BIS) monitor were applied. Patients underwent rapid-sequence induction with intravenous (IV) propofol two mg/kg and either remifentanil 4 μg/kg IV or succinylcholine 1.5 mg/kg IV. An experienced anesthesiologist, blinded to patient group assignment, performed intubation after 60 seconds.
MEASUREMENTS: IOP, heart rate (HR), blood pressure, BIS scores, intubating conditions, and response to intubation (coughing or moving) were recorded at baseline, immediately after completion of induction, one minute after intubation, and three minutes after intubation. Time to return of spontaneous ventilation was also measured.
MAIN RESULTS: Remifentanil produced a 39% decrease in IOP immediately after induction, which remained unchanged by laryngoscopy and intubation (P < 0.001). IOP remained below baseline even in patients who coughed or moved in response to intubation. Remifentanil caused a significant decrease in mean arterial pressure of 24% to 31% but no significant change in HR, and it blocked the hemodynamic response to laryngoscopy and intubation while providing intubating conditions comparable to those of succinylcholine.
CONCLUSIONS: Propofol/remifentanil induction provides adequate intubating conditions, prevents an increase in IOP, and controls the hemodynamic stress response to laryngoscopy and intubation.
Sherine F Hanna; Fatima Ahmad; Ana Lucia S Pappas; Marianne Mikat-Stevens; W Scott Jellish; Bruce Kleinman; Michail N Avramov
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  22     ISSN:  1873-4529     ISO Abbreviation:  J Clin Anesth     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  437-42     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Department of Anesthesiology, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL 60153, USA.
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MeSH Terms
Ambulatory Care
Anesthetics, Intravenous / administration & dosage,  pharmacology*
Blood Pressure / drug effects
Consciousness Monitors
Double-Blind Method
Heart Rate / drug effects
Intraocular Pressure / drug effects*
Intubation, Intratracheal / methods
Laryngoscopy / methods
Middle Aged
Piperidines / administration & dosage,  pharmacology*
Propofol / administration & dosage,  pharmacology*
Surgical Procedures, Elective / methods
Time Factors
Young Adult
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol

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