The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure

Abstract 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 Conclusions Propofol/remifentanil induction provides adequate intubating conditions, prevents an increase in IOP, and controls the hemodynamic stress response to laryngoscopy and intubation.