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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 Maggio;75(5):239-44
Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery
Apan A. 1, Doganci N. 1, Ergan A. 2, Büyükkoçak Ü. 1
1 Department of Anesthesiology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey;
2 Department of Ophthalmology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
Background. This study aimed to evaluate the role of a-2 agonist infusion, with dexmedetomidine or midazolam, on hemodynamic and respiratory parameters while titrating the sedation level with the bispectral index (BIS) during cataract surgery.
Methods. Ninety consenting ASA class I-III patients who were electively undergoing cataract surgery were enrolled in the double blind study. A random infusion of 0.25 mg¥kg-1¥hr-1 Dexmedetomidine (Group D), 25 mg ¥ kg-1.hr-1 midazolam (Group M), or saline for controls (Group C) was administered after mounting a BIS monitor and routine anesthetic care. The target BIS level was >85. An additional bolus dose in 1 mL increments of the study drug or cessation of the infusion was adjusted according to the BIS level. Changes in respiratory and vital parameters were noted and, in case of mild pain, 25 mg fentanyl was administered as a bolus. Pain and sedation were evaluated in the early postoperative period using visual analogue and four rating sedation scales.
Results. In Group D, heart rate decreased in the later periods of surgery (35-50 min) and in the early postoperative period (5th and 15th min). Dose adjustments were required in six and ten patients in Groups D and M, respectively. Pain scores were lower with dexmedetomidine infusion.
Conclusion. Dexmedetomidine infusion mildly decreased heart rate in the later periods of surgery with better pain scores in the postoperative period. Dexmedetomidine should be an alternative for intraoperative sedation in outpatient cataract surgery.