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BJA Advance Access published online on April 4, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael080
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 2, 2006

Clinical Investigation

Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery

J. A. Alhashemi 1 *

1 Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, PO Box 31648, Jeddah, Saudi Arabia

* To whom correspondence should be addressed.
J. A. Alhashemi, E-mail: jalhashemi{at}kau.edu.sa


  Abstract

Background. Cataract surgery is commonly performed under local anaesthesia with midazolam sedation. Dexmedetomidine, a sedative-analgesic, is devoid of respiratory depressant effects, and its use in cataract surgery has not been reported. This double-blind study compared the use of dexmedetomidine and midazolam in patients undergoing cataract surgery.

Methods. Forty-four patients undergoing cataract surgery under peribulbar anaesthesia randomly received either i.v. dexmedetomidine 1 µg kg-1 over 10 min; followed by 0.1-0.7 µg kg-1 h-1 i.v. infusion (Group D), or midazolam 20 µg kg-1 i.v.; followed by 0.5 mg i.v. boluses as required (Group M). Sedation was titrated to a Ramsay sedation score of 3. Mean arterial pressure (MAP), heart rate (HR), readiness for recovery room discharge (time to Aldrete score of 10), and patients' and surgeons' satisfaction (on a scale of 1-7) were determined.

Results. MAP and HR were lower in Group D compared with Group M [86 (SE 3) vs 102 (3) mm Hg and 65 (2) vs 72 (2) beats min-1, respectively] (P<0.05). Group D patients had slightly higher satisfaction with sedation [median (IQR): 6 (6-7) vs 6 (5-7), P<0.05], but delayed readiness for discharge [45 (36-54) vs 21 (10-32) min, P<0.01] compared with patients in Group M. Surgeons' satisfaction was comparable in both groups [5 (4-6) vs 5 (4-6)].

Conclusion. Compared with midazolam, dexmedetomidine does not appear to be suitable for sedation in patients undergoing cataract surgery. While there was a slightly better subjective patient satisfaction, it was accompanied by relative cardiovascular depression and delayed recovery room discharge.

Keywords: recovery; sedation, dexmedetomidine; sedation, midazolam; sedation, monitored anaesthesia care; surgery, ophthalmological.
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