A comparison of propofol, midazolam, and methohexital for sedation during retrobulbar and peribulbar block.
OBJECTIVE
To compare the efficacy of propofol, methohexital, and midazalom in providing adequate sedation during administration of retrobulbar block and satisfactory postoperative amnesia.


METHODS
Retrospective chart review over a 4-month period.


METHODS
Ambulatory patients in the main operating room of a university-affiliated hospital.


METHODS
One hundred forty-seven ambulatory patients undergoing ophthalmologic surgery of less than 2 hours' duration under regional anesthesia consisting of retrobulbar or peribulbar block and intravenous (IV) sedation.


METHODS
One of three drugs--propofol 0.47 +/- 0.06 mg/kg, midazolam 0.02 +/- 0.005 mg/kg, or methohexital 0.45 +/- 0.16 mg/kg--was administered IV. Patients were observed for a minimum of 60 seconds or until adequate sedation was achieved, after which a retrobulbar or peribulbar block was performed.


RESULTS
Blood pressure, electrocardiogram, and oxygen saturation were monitored and recorded. Patients were observed for apnea, hiccups, pain on injection, excitement, tremor, grimacing, or verbal response during the block. The requirement for additional sedation intraoperatively was noted. Patients were questioned postoperatively in the ambulatory recovery room for recall of needle insertion or discomfort during the block, as well as about their satisfaction with the overall experience.


CONCLUSIONS
Grimacing or verbal response during the retrobulbar or peribulbar block did not predict or correlate with patient recall. Propofol was equal to both midazolam and methohexital in providing adequate sedation and postoperative amnesia but possesses the added advantages of reduced postoperative vomiting, lower intraocular pressure, and earlier return-to-home readiness.
Ferrari
L R
LR
Department of Anaesthesia, Harvard Medical School, Boston, MA.
Donlon
J V
JV
D000556:Ambulatory Surgical Procedures; D003365:Costs and Cost Analysis; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000191:economics; D007275:Injections, Intravenous; D008723:Methohexital / Q000008:administration & dosage* / Q000191:economics; D008874:Midazolam / Q000008:administration & dosage* / Q000191:economics; D009407:Nerve Block; D013508:Ophthalmologic Surgical Procedures; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics
D006993:Hypnotics and Sedatives; D008723:Methohexital; D008874:Midazolam; D015742:Propofol