Dexmedetomidine sedation during cataract surgery under regional anaesthesia

Ayoğlu, Hilal; Altunkaya, Hanife; Özer, Yetkin; Yapakçi, Osman; Özkoçak, Işıl; Oz, Oganesian; Alpay, Atilla; Uğurbaş, Suat Hayri

doi:10.1093/bja/aem226

Cited by 22 publications

(32 citation statements)

References 5 publications

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“…Bu sedatif ajanlar arasında en sık kullanılanlar propofol, midazolam ve opioidlerdir (14,15). Selektif α 2 adrenoreseptör agonisti olan deksmedetomidinin de katarakt cerrahisinde başarı ile kullanıldığı bildirilmektedir (1,12,(16)(17)(18). Deksmedetomidinin analjezik ve anksiyolitik etkilerini solunum depresyonu yapmadan göstermesi, en büyük avantajı olarak gözükmektedir (1).…”

Section: Discussionunclassified

“…Seçilen sedatif ilaçların göz içi basıncını düşürücü etkilerinin de olmasının, oküler içeriğin cerrahi yada travmatik yaradan dışarı çıkmasını engelleyerek oftalmik girişimlerde başarının artmasını ve komplikasyon oranlarının düşmesini sağlayabi-leceği belirtilmektedir (41,42). Çalışma ilaçlarımızdan hem deksmedetomidinin hem de ketamin-propofol kombinasyonunun İOB'yi düşürdüğü bilinmektedir (1,15,18,43).…”

Section: Discussionunclassified

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Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Yağan¹,

Karakahya²,

Taş³

et al. 2015

Turk J Anesth Reanim

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Objective: The aim of this study is to compare the sedative properties and haemodynamic and respiratory effects of dexmedetomidine and a ketamine-propofol combination (ketofol), which are expected to have minimal effects on spontaneous breathing. Methods:Sixty patients were enrolled in this prospective randomised study. Patients were divided into 2 groups according to the administration of dexmedetomidine (Group D) and ketofol (Group K). Target sedation level was determined as a Ramsay Sedation Score of 3. In Group D, 0.5 mcg kg -1 dexmedetomidine was administered via intravenous route in 10 minutes versus 0.125 mL kg -1 of a solution containing 200 mg propofol and 100 mg ketamine in Group K. Haemodynamic and respiratory effects, postoperative awakening time, analgesic properties and satisfaction levels of the patients and surgeon were assessed.Results: There was a statistically significant decrease in mean arterial pressures following drug administration compared to initial measurements in both groups. However, there was a statistically significant decrease in heart rate only in Group D. There was no significant difference between the two groups regarding respiratory rate and protection of spontaneous respiration. Although the time for Aldrete score to be 9 was 16.1 minutes for Group K, it was 24.9 minutes for Group D, and this difference was statistically significant (p<0.01). There was no significant difference between the two groups regarding adverse effects, pain scores and satisfaction levels of the patients and surgeon.Conclusion: Compared to dexmedetomidine, at similar sedation levels, sedation provided by ketofol enables satisfactory analgesia. Moreover, ketofol has a more rapid onset of action and a shorter recovery period from anaesthesia without causing significant haemodynamic or respiratory adverse effects. Bulgular:Her iki grupta da ortalama arter basınçları ilaç uygulamaları sonrası başlangıç ölçümlerine oranla anlamlı bir azalma gösterdi. Kalp atım hızı ise sadece Grup D'de anlamlı olarak azaldı. Solunum sayısı ve spontan solunumun korunması açısından iki grup arasında fark yoktu. Aldrete puanının 9 olma zamanı Grup K'da 16,1 dk iken Grup D'de 24,9 dk idi ve aralarındaki fark istatistiksel açıdan anlamlıydı (p<0,01). Yan etkiler, ağrı skorları, hasta ve cerrah memnuniyeti açısından gruplar arasında anlamlı farklılık yoktu.Sonuç: Çalışmamız sonucunda ketofol ile oluşturulan sedasyonun deksmedetomidinle karşılaştırıldığında, benzer sedasyon seviyesinde yeterli analjezi sağladığını ve hemodinamik ve solunumsal açıdan önemli bir yan etkiye yol açmaksızın daha kısa etki başlan-gıcı ve daha kısa derlenme süresine sahip olduğunu tespit ettik. 84 Giriş K atarakt cerrahisi ve vitreoretinal cerrahi en sık uygulanan oftalmik cerrahi prosedürlerdir ve genellikle sedasyon eşli-ğinde veya sedasyon olmadan lokal anestezi (LA) altında gerçekleştirilir (1, 2). Sedasyon amacıyla sıklıkla propofol, benzodiyazepinler, opioidler ve bunların kombinasyonları kullanılmaktadır. Katarakt cerrahisi çoğunlukla ileri yaş-t...

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Section: Discussionunclassified

Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Yağan¹,

Karakahya²,

Taş³

et al. 2015

Turk J Anesth Reanim

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“…Ayoglu et al [19] demonstrated that intraocular pressure was decreased and satisfactory sedation and analgesia were achieved by a sole loading infusion of 1 µg/kg dexmedetomidine for 10 min preoperatively. Apan et al [20] also reported that dexmedetomidine made the intraoperative HR more stable and postoperative pain less severe compared with midazolam, thus it was appropriate for sedation and analgesia during MAC in cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery

Song

Park

et al. 2011

Korean J Anesthesiol

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BackgroundDexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil.MethodsThirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 µg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 µg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO2) were recorded throughout the surgery. For the second operation, the group assignments were exchanged.ResultsPostoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P < 0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR, and SpO2 were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1 case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D.ConclusionsCompared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.

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“…The ability of the surgeon to perform scleral buckle and retinal cryopexy procedures under topical anesthesia attests to the efficiency of the drug in providing safe, awake sedation and analgesia 11. The intraocular pressure lowering effect of dexmedetomidine3,4 facilitates the treatment of open globes under dexmedetomidine, and we treated one patient accordingly (Table 1). Unlike in the findings of Alhashemi,5 the use of dexmedetomidine did not prolong the recovery period.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine sedation in painful posterior segment surgery

Mansour¹,

Taha²

2012

OPTH

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PurposeTo present a case series on the use of dexmedetomidine (Precedex) sedation in painful posterior segment surgery performed under topical anesthesia, similar to its use in cataract surgery.MethodsA prospective review of cases that had posterior segment surgery under topical anesthesia and that needed sedation. Dexmedetomidine-loading infusion was 1 mcg/kg over 10 minutes, followed by a maintenance infusion (0.5 mcg/kg/h).ResultsNine patients were operated on under topical anesthesia: two scleral buckle, five cryopexy, one scleral laceration, and one pars plana vitrectomy with very dense laser therapy in an albinotic fundus; six patients had retinal detachment. General or local anesthesia were not possible due to medical or ocular morbidities, use of anticoagulants, or the surgery plan changed intraoperatively when new pathologies were discovered. The surgeon achieved good surgical control in eight of nine cases, with one patient having ocular and bodily movements that were disturbing. Six patients had no pain, while three patients reported mild pain. No adverse effects were noted and all patients had successful surgical outcomes. Heart rate, blood pressure, and oxygen saturation were well controlled throughout the procedures. The most frequent adverse reactions of dexmedetomidine reported in the literature in less than 5% (hypotension, bradycardia, and dry mouth) were not recorded in the present study.ConclusionWhen a surgeon has planned to do a pars plana vitrectomy under topical anesthesia and the surgical situation dictates the addition of cryopexy, scleral buckle, or intense laser retinopexy, then sedation with dexmedetomidine can help in the control of ocular pain in the majority of cases, with good intraoperative and immediate postoperative hemodynamic control with the possibility of supplemental rescue analgesia. Dexmedetomidine, a sedative analgesic, is devoid of respiratory depressant effects, and its use in posterior segment surgery under topical anesthesia is reported here for the first time.

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Dexmedetomidine sedation during cataract surgery under regional anaesthesia

Cited by 22 publications

References 5 publications

Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery

Dexmedetomidine sedation in painful posterior segment surgery

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