Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction

Ghodki, Poonam S; Sardesai, Shalini; Halikar, Swapnagandha S.

doi:10.1080/22201181.2015.1028225

Cited by 12 publications

(22 citation statements)

References 19 publications

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“…Two studies titrated dexmedetomidine, remifentanil, and midazolam to pre-determined target levels of sedation as defined by Bispectral index (BIS) scores 70-80 and > 85 [10,11]. Of the remaining studies, 7 titrated medications to Ramsay Sedation Scale (RSS) scores of 2 or 3 [12][13][14][15][16][17][18]. Two studies administered intramuscular (IM) dexmedetomidine 45 min prior to the regional block [19,20].…”

Section: Routes Of Administration Dosing and Titration Of Medicationsmentioning

confidence: 99%

“…− 1 without initial boluses; arterial pressures that defined hypotension in these studies, however, were not specifically provided [17,24]. Omitting a continuous infusion of dexmedetomidine was not associated with preserved arterial pressure or heart rate in any of the studies included in this review [15,[18][19][20]. Table 3 displays the effects of dexmedetomidine on arterial pressure and heart rate compared to other study medications and placebo.…”

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

“…However, one study comparing the effects of dexmedetomidine to midazolam or saline in 90 patients did not bolus dexmedetomidine, and reported statistically significant decreases in intraoperative and postoperative heart rates [11]. Bradycardia was reported as an adverse event in 5 studies and frequently required atropine treatment [15,17,[19][20][21]. No statistically significant differences in oxygen saturation (SpO 2 ), end-tidal carbon dioxide (ETCO 2 ) values, or respiratory rates were reported in studies investigating the respiratory effects of dexmedetomidine compared to saline; no sedation; midazolam and fentanyl; propofol and alfentanil; and ketamine and propofol (ketofol) [10-15, 17-19, 21].…”

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

“…Increased intraoperative levels of sedation as measured by Observer Assessment of Alertness/Sedation Scale (OAA/S) and BIS were noted when dexmedetomidine was compared to remifentanil [24]. Increased sedation was also noted with dexmedetomidine compared to saline as measured by BIS and RSS [15,23]. Increased postoperative sedation lasting up to 3 h postoperatively as measured by 4-point sedation score was reported in one study comparing dexmedetomidine to midazolam and saline [11].…”

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

“…Four studies investigated the time necessary to achieve a pre-determined target Aldrete score [12,13,15,18]. One study noted that dexmedetomidine-treated patients required more time to achieve an Aldrete score of 10 when compared to midazolam-treated patients [median interquartile range (IQR): 45 (36-54) vs 21 (10-32) min, P < 0.01] [12].…”

Section: Pacu Discharge and Recovery Timesmentioning

confidence: 99%

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Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

Jones

Aldwinckle

2020

BMC Anesthesiol

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Background: Cataract surgery is one of the most common procedures performed worldwide in the elderly. Various medications can provide effective anesthesia and analgesia for cataract surgery, but undesirable side effects limit the utility of each medication or combination of medications. Dexmedetomidine may serve as an anesthesia adjunct for outpatient cataract surgery in the elderly. Methods: Searches were conducted in Cochrane, Embase, and PubMed for randomized clinical trials investigating the use of dexmedetomidine in adult patients undergoing outpatient, or ambulatory, cataract surgery with sedation and topical or peribulbar block. Ninety-nine publications were identified, of which 15 trials satisfied the inclusion criteria. A total of 914 patients were included in this review. The following data were collected: American Society of Anesthesiologists' (ASA) physical status and age of study patients; method of blinding and randomization; medication doses and routes of administration; and intraoperative levels of sedation. We also recorded statistically significant differences between dexmedetomidine and other study medications or placebo with respect to the following outcomes: hemodynamic and respiratory parameters; pain; sedation; post-operative nausea and vomiting (PONV); discharge from post-anesthesia care unit (PACU) or recovery times; patient satisfaction; surgeon satisfaction; and effects on intraocular pressure (IOP). Results: Hypotension with or without bradycardia was reported following bolus doses of dexmedetomidine ranging from 0.5-1.0 mcg/kg with or without a continuous dexmedetomidine infusion. Delayed PACU discharge times were associated with the use of dexmedetomidine, but no clear association was identified between delayed recovery and higher levels of intraoperative sedation. Better analgesia and higher patient satisfaction were commonly reported with dexmedetomidine as well as reductions in IOP. Conclusions: Overall, this review demonstrates better analgesia, higher patient satisfaction, and reduced IOP with dexmedetomidine for outpatient cataract surgery when compared to traditional sedatives, hypnotics, and opioids. These benefits of dexmedetomidine, however, must be weighed against relative cardiovascular depression and delayed PACU discharge or recovery times. Therefore, the utility of dexmedetomidine for outpatient cataract surgery should be considered on a patient-by-patient basis.

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Section: Routes Of Administration Dosing and Titration Of Medicationsmentioning

confidence: 99%

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

Section: Hemodynamic and Respiratory Parametersmentioning

confidence: 99%

Section: Pacu Discharge and Recovery Timesmentioning

confidence: 99%

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Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

Jones

Aldwinckle

2020

BMC Anesthesiol

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Response to the letter,Williams syndrome: was intubation rather than anaesthetic drug choice a cause of cardiac arrest?

Toit-Prinsloo

Dippernaar

2015

Southern African Journal of Anaesthesia and Analgesia

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Evaluation of Intranasal Dexmedetomidine as a Procedural Sedative for Ophthalmic Examination of Children With Glaucoma

Dhingra¹,

Ghai

Sabharwal

et al. 2020

Journal of Glaucoma

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Precis: This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose of 3.5 µg/kg was more efficacious and obviated the need for repeated general anesthesia. Purpose: This study was carried out to determine the safety and effective dose of IND as a procedural sedative for postoperative follow-up examinations after glaucoma surgery in children in place of repeated examination under anesthesia. Materials and Methods: In this prospective randomized double-blinded interventional study, consecutive children aged 6 months to 6 years were randomized to receive 3.0 and 3.5 µg/kg IND using a mucosal atomizer device in the preoperative area of the operating room, under continuous monitoring of vital signs. Intranasal midazolam 0.25 mg/kg was used as a rescue agent in case of inadequate sedation, and general anesthesia was administered in case of persistent failure. All infants underwent a complete anterior and posterior segment evaluation including intraocular pressure and corneal diameter measurements. Results: A total of 30 and 31 children aged 23.9±15.0 and 19.2±10.1 months, respectively, received 3.0 and 3.5 µg/kg IND. Adequate sedation was possible in 18 of 30 (60%) children receiving 3.0 µg/kg and 24 of 31 (77.4%) receiving 3.5 µg/kg IND alone (P=0.17). In combination with midazolam, successful sedations were 86.6% versus 100%, respectively (P=0.052). One patient in the 3.5 µg/kg group had ventricular arrhythmia, reversed with dextrose-saline infusion and injection glycopyrrolate. Conclusions: IND appears to be a safe and effective procedural sedative for postoperative follow-up examinations of pediatric glaucoma patients at doses of 3 and 3.5 µg/kg. The dose of 3.5 µg/kg was successful in more children.

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Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction

Cited by 12 publications

References 19 publications

Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

Response to the letter,Williams syndrome: was intubation rather than anaesthetic drug choice a cause of cardiac arrest?

Evaluation of Intranasal Dexmedetomidine as a Procedural Sedative for Ophthalmic Examination of Children With Glaucoma

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