Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

Abstract

Background According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure. Objectives The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field. Methods The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients’ and surgeons’ satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups. Results In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients’ mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006). Conclusions The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients’ satisfication scores, it is suggested that propofol was superior to the other two agents.

Perioperative Anxiolytic and Analgesic Effects of Pregabalin in Vitreo-Retinal Surgery: A Randomized, Double-blind Study

“…In the current study, we recorded the level of sedation based on the Ramsay sedation scale, which is useful in assessing the clinical effects of sedative agents (11,12). Our results are compatible with the literature where those administered with pregabalin premedication experienced less pain during the procedure, as well as higher sedation scores and low anxiety levels, especially in other ophthalmic surgeries (13,14).…”

Effect of Benson’s Relaxation Technique on Propofol Consumption and Preoperative Anxiety of Patients Undergoing Cataract Surgery

“…The primary aim of this study was to investigate the effect of Benson's non-pharmacological relaxation therapy on preoperative anxiety and the amounts of propofol consumption for the induction and maintenance of anesthesia during cataract surgery. One of the most surgeries in ophthalmology is cataract surgery (10,11). Based on the obtained results, it can be concluded that Benson's relaxation method effectively reduced preparative anxiety in patients of this study who underwent cataract surgery.…”

Anesthesia Considerations for Cataract Surgery in Patients with Schizophrenia: A Narrative Review

“…Midazolam and propofol are the commonly used agents, while a short acting opioid (e.g., alfentanil and fentanyl) is sometimes added to supplement analgesia ( 46 ). The Ramsay sedation score may be useful to assess their clinical effects ( 47 ).…”