[Role of deep sedation phacoemulsification with scleral tunnel].
OBJECTIVE
To describe a method of deep sedation without adjunctive periocular injection in phacoemulsification with a scleral tunnel technique.


METHODS
All patients undergoing phacoemulsification with a scleral tunnel and foldable intraocular lens for cataract between May 2011 and November 2014 received deep sedation including a bolus of midazolam and fentanyl followed by a continuous perfusion of dexmedetomidine throughout the surgical procedure. The patients and medical team evaluated pain, sedation, clinical status of the patient, and surgeon comfort.


RESULTS
One thousand and five hundred patients were included, representing 1763 eyes. Ramsay's sedation score was 2 in 7.13% of cases and 3 in 86.3%, which allowed surgery to be performed under very satisfactory conditions. On a scale of 1 to 10, intraoperative pain was less than or equal to 1 in 81.2% of cases. The bradycardic and hypotensive effects of dexmedetomidine were appreciable, while respiratory depression was not observed. Only 1 case of severe agitation during surgery directly resulted in a vitreous issue. Some simple precautions allow optimization of the advantages of this method of anesthesia.


CONCLUSIONS
The deep sedation method including bolus injections of midazolam and fentanyl and continuous perfusion of dexmedetomidine affords a certain comfort to the patient as well as the surgeon in phacoemulsification of cataract through a scleral tunnel without adjunctive periocular injection.
Service d'ophtalmologie, Labib Medical Centre, rond-point ELIA, immeuble Dandachli Plaza, BP 644, Saïda, Liban. Electronic address: domoukas@hotmail.com.
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Kassir
Service d'anesthésie-réanimation, Victoria Hospital, Riyad, Arabie Saoudite; Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban.
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Kassas
Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban.
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Ajine
Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban.
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Hammoud
Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban.
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Mahmoud
D000759:Adjuvants, Anesthesia; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054810:Deep Sedation; D020927:Dexmedetomidine; D005260:Female; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives; D007910:Lenses, Intraocular; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D018918:Phacoemulsification; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D055815:Young Adult
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D005283:Fentanyl
Comfort; Confort; Deep sedation; Dexmedetomidine; Douleur; Pain; Phacoemulsification; Phacoémulsification; Safety; Scleral tunnel; Sécurité; Sédation profonde; Tunnel scléro-cornéen