Optimal target concentration of remifentanil during cataract surgery with monitored anesthesia care

Study objectiveTo determine the effect-site target concentration (C_et) of remifentanil that provides optimal conditions for patients and operators during cataract surgery during monitored anesthesia care using a target controlled infusion (TCI) of propofol and remifentanil.DesignProspective, randomized, double-blinded study.SettingOperating room and postoperative recovery area of a university-affiliated hospital.Patients66 adult, ASA physical status I, II, and III patients undergoing cataract surgeryInterventionsGroup I received C_et of remifentanil 0.5 ng/mL; Group 2 received C_et of remifentanil one ng/mL; and Group 3 received C_et of remifentanil 1.5 ng/mL. After giving TCI propofol (C_et; one μg/mL) - remifentanil, an ophthalmologist administered topical anesthesia.Measurements and main resultsIntraoperative hemodynamics, pain scores, sedation scores, patient satisfaction scores, and operators’ satisfaction scores regarding surgical conditions were recorded. No statistical differences in heart rate or mean blood pressure were detected among the three groups during surgery. Pain scores (Group 1: 31.9 ± 17.9 vs. Group 2: 11.8 ± 7.7 and Group 3: 11.8 ± 7.7; P < 0.05) were higher and patient satisfaction scores (Group 1: 4.7 ± 0.8 vs. Group 2: 5.4 ± 0.4 and Group 3: 5.5 ± 0.4; P < 0.05) were lower in Group 1 than Groups 2 and 3. On the other hand, surgeon satisfaction was lowest in Group 3 (Group 3: 2.9 ± 1.3 vs. Group 1: 4.7 ± 0.4 and Group 2: 4.6 ± 0.7; P < 0.05) due to ocular movement.ConclusionC_et values of remifentanil and propofol of one ng/mL and one μg/mL, respectively, appear to provide optimal conditions for patients and operators during cataract surgery using monitored anesthesia care with TCI.