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Anaesthesia with remifentanil infusion in diabetic versus non-diabetic patients undergoing vitrectomy. A Holter-controlled study.

Diabetic patients are known to have additional risks in surgery. We evaluated haemodynamic profiles, incidence of arrhythmias and post-operative recovery when remifentanil infusion was used for vitrectomies. We compared 22 diabetics with 22 age-matched controls undergoing vitrectomy. ECG Holter monitoring was continued throughout the operation and until 20 hours postoperatively. Autonomic tests including breathing and stand up were performed in the beginning of Holter-monitoring. Anaesthesia was induced with a bolus of remifentanil (1 microg/kg) and continued with 0.4 microg/kg/ h. Thereafter, propofol, 0.5 mg/kg, was given with additional doses of 0.25 mg/kg if needed. Anaesthesia was maintained with 40% oxygen in air and 0.5% isoflurane. After the operation time to obey commands, pain scores, nausea and vomiting, and haemodynamic parameters were registered. Both breathing and stand up tests differed statistically between the groups (p = 0.001 and p = 0.000, respectively). Diabetic patients needed less remifentanil (p = 0.039) than controls. Hypotensive periods were more frequent in diabetic patients (p = 0.013) and they needed more etilefrine than controls (p = 0.014). Holter recordings revealed no ischaemic episodes in either group. Periods of short ventricular and supraventricular extra beats occurred without any clinical relevance in both groups. Time to obey commands or need for pain medicine postoperatively did not differ between the groups. Diabetic patients were haemodynamically more instable with more frequent hypotensive periods during anaesthesia despite of less amount of remifentanil compared to controls. On the other hand, during remifentanil infusion no ischaemic or clinically significant arrhythmic episodes occurred in either group.