The effect of remifentanil on hemodynamic response to laryngeal mask airway insertion in induction of anesthesia with propofol fentanyl or propofol ketamine in cataract surgery

Background. Induction of general anesthesia may cause hemodynamic instability. Remifentanil is often prescribed to suppress the hemodynamic response to anesthesia. The aim of this study was to investigate the effect of remifentanil on hemodynamic response to induction of anesthesia with propofol fentanyl or propofol ketamine and laryngeal mask airway (LMA) insertion.

Methods. This double-blind randomized clinical trial study was performed on 44 candidates for cataract surgery in Feyz Hospital, Isfahan, Iran from March to June 2020. Patients were randomly assigned into two groups using random allocation software. The first group received 1 mcg/kg fentanyl and the second group received 0.5 mg/kg ketamine. Also, both groups received 1 mg/kg propofol and 0.5 mcg/kg remifentanil intravenously. Hemodynamic parameters were measured and recorded at study times, and the results were analyzed statistically.

Results. The mean age (P=0.199), weight (P=0.050), height (P=0.9), and frequency distribution of gender (0.763) and American Society of Anesthesiologists (ASA) score (0.069) were not significantly different between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in fentanyl group were significantly lower than the ketamine group immediately before LMA insertion, as well as 1, 3, and 5 minutes after LMA insertion (P <0.050). In addition, the mean heart rate (HR) in the fentanyl group decreased significantly at different time (P<0.001), but no significant difference was observed in ketamine group (P=0.056). In addition, the mean HR did not differ significantly between the two groups in any of the follow-up times (P>0.050).

Conclusion. Intravenous administration of remifentanil in induction of anesthesia with propofol-ketamine and propofol-fentanyl reduced changes in hemodynamic responses to LMA insertion. This hemodynamic stability was increased by adding remifentanil to the propofol-ketamine combination.

Practical Implications. Remifentanil is associated with weakening of hemodynamic responses to LMA insertion in induction of anesthesia with propofol and ketamine or propofol and fentanyl; this effect can be associated with safety in cardiac patients.