Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery.
BACKGROUND
This study aimed to evaluate the role of alfa-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 microg kg(-1) hr(-1) Dexmedetomidine (Group D), 25 microg 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 microg 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 (5(th) and 15(th) min). Dose adjustments were required in six and ten patients in Groups D and M, respectively. Pain scores were lower with dexmedetomidine infusion.


CONCLUSIONS
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.
Apan
A
A
Department of Anesthesiology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey. alpaslanapan@gmail.com
Doganci
N
N
Ergan
A
A
Büyükkoçak
U
U
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000494:pharmacology; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000765:Anesthesia, Conduction; D002387:Cataract Extraction; D054810:Deep Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000494:pharmacology; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009294:Narcotics / Q000008:administration & dosage; D017060:Patient Satisfaction; D012119:Respiration / Q000187:drug effects
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D009294:Narcotics; D020927:Dexmedetomidine; D008874:Midazolam; D005283:Fentanyl