Comparison of recovery time and complications in general anesthesia with remifentanyl and propofol and topical anesthesia with conscious sedation in non -complicated cataract phaco surgery

ABSTRACT

Eye surgery especially cataract surgery is done at an ambulatory basis under local or general anesthesia. Remifentanyl is an ultra-short-acting opioid and propofol is a short-acting anesthetic. They may be used for maintenance of anesthesia. The aim of this study was evaluating and comparing the hemodynamic changes, recovery time, and complications between these drugs and topical anesthesia in non-complicated cataract phaco surgery. This clinical trial study was carried out in a 6 months period in 2006 at Khatam Hospital, Mashhad. Patients with non-complicated cataract surgery were divided into 3 groups of 25 control, remifentanil and propofol groups. Topical anesthesia was used in the first group. In the second and third groups induction was done by propofol, Atracorium and LMA. Maintenance of anesthesia in second group was done with propofol 5 mg/kg/h and in third group with remifentanil 0.25 micro g/kg/min. All the procedures were done by a surgeon. Patients were monitored on NIBP, HR, Spo2 continuously and recovery complications were checked. The patients with cardiopulmonary disorders, hypertension and p-blocker usage were excluded from this study. Data was analyzed by SPSS 13 software, ANOVA, Chi-square, fisher exact test and regression. P patient in the first group and two patients in the second group were omitted due to cancellation of surgery and arrest. There was no demographic difference among the groups. Hypotension and bradycardia in remifentanil group was more common than propofol group [P=0.005]. Recovery time in remifentanil was shorter than propofol [P=0.000] and recall in propofol was more common than remifentanil [P=0.024]. There was no significant difference among groups in nausea and vomiting [P=0.38]. In this study local anesthesia with conscious sedation had less complications and more rapid discharge, therefore is better than general anesthesia. If using general anesthesia, Due to fast recovery and less recall, remifentanil is more suitable than propofol for eye surgery but because of hypotension and bradycardia it is better be used in low doses