Comparison of intravenous remifentanil and dexmedetomidine infusions' effects on intraocular pressure and hemodynamy in dacryosystorinostomy operations

Abstract

Aim: To compare the effects of intravenous infusion of remifentanil and dexmedetomidine on intraocular pressure (IOP) and hemodynamics of patients who underwent dacryocystorhinostomy (DCR) operation.

Methods: Ninety consecutive patients aged between 20 and 65 who had lacrimal duct stenosis or occlusion scheduled for elective DCR operation were included in the study. Patients were divided into 3 groups as control (Group C), remifentanil infusion (Group R) and dexmedetomidine infusion (Group D). Peroperative intraocular pressures and hemodynamics were evaluated.

 Results: According to intraocular pressure levels; although the IOP decreased at the drug loading dose, induction, preextubation and postextubation, it was statistically significantly higher in Group C than in Group R and Group D (p<0,001). Concominantly, IOP was higher in Group R than in Group D during the time periods listed above. Although IOP measurements at the 1st and 5th minutes of intubation decreased compared to the preoperative value, they were higher than those in Group C, Group R, and Group D; 16.43±1.48 mmHg and 15.62±1.43 mmHg respectively (p < 0.001).  However, in these periods there was no statistically significant difference between Group R and Group D. In the postoperative period, the IOP measurements of Group D were significantly lower than those of Group C and Group R, 16.81±1.65 mmHg, 18.21±1.98 mmHg, 18.17±1.29 mmHg, respectively (p< 0.002). Blood pressure and heart rate values decreased more in Group R and Group D compared to Group C during the operation (p < 0.001).     

Conclusions: Remifentanil and dexmedetomidine are agents that can be used in intravenous infusions for controlled hypotension in eye surgeries where low IOP is desired. Intraoperative hemodynamic effects are similar. However, considering that it decreases IOP values more in the intraoperative period and lowers IOP values in the postoperative period compared to remifentanil, we believe that dexmedetomidine can be preferred primarily.