Clorazepate dipotassium versus midazolam for premedication in clear corneal cataract surgery.
OBJECTIVE
To evaluate and compare the efficacy of oral clorazepate dipotassium (Tranxilium) and intravenous midazolam (Dormicum) as premedication agents in retrobulbar anesthesia and clear corneal phacoemulsification with intraocular lens (IOL) implantation.


METHODS
Department of Ophthalmology, University of Essen, Essen, Germany.


METHODS
In a prospective clinical trial, 97 consecutive patients (97 eyes) having phacoemulsification with implantation of a foldable IOL were randomized to 2 groups. The first group received 10 mg oral clorazepate dipotassium and the second group, 1 mg intravenous midazolam. The surgeon's subjective experience of patients' cooperation during retrobulbar anesthesia and after surgery was measured on a 5-point Likert scale. The duration of surgery and rate of complications were documented. One day after surgery, the patients' subjective comfort during cataract surgery was evaluated using a 5-point Likert scale and the best corrected visual acuity was determined.


RESULTS
The level of anterograde amnesia tended to be higher in the midazolam group than in the clorazepate dipotassium group (4% versus 0% for anesthesia administration; 14% versus 4% for surgery), but the difference between groups was not significant. There were no significant differences in patient cooperation or complications during surgery. Patient satisfaction scores were not significantly different between the groups (P<.14); however, patients in the midazolam group expected to have significantly less pain during surgery (P<.04). The rate of potential visual acuity recovery was similar between groups.


CONCLUSIONS
Anterograde amnesia occurred more frequently and patients expected less pain before surgery with midazolam. Both anesthetic agents provided safe and effective premedication for retrobulbar anesthesia in clear corneal cataract surgery.
Laube
Thomas
T
Department of Ophthalmology, University of Essen, Essen, Germany. thomas.laube@uni-essen.de
Krohner
Hyunil
H
Franke
Gabriele Helga
GH
Brockmann
Claudia
C
Steuhl
Klaus Peter
KP
D000284:Administration, Oral; D000368:Aged; D020324:Amnesia, Anterograde / Q000139:chemically induced; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003009:Clorazepate Dipotassium / Q000009:adverse effects / Q000627:therapeutic use*; D003315:Cornea / Q000601:surgery*; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control; D018918:Phacoemulsification / Q000379:methods*; D011292:Premedication; D014792:Visual Acuity
D018686:Anesthetics, Intravenous; D014151:Anti-Anxiety Agents; D003009:Clorazepate Dipotassium; D008874:Midazolam