Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

Kumar, Chandra M.; Chua, Alfred Wy; Imani, Farnad; Sehat-Kashani, Saloome

doi:10.5812/aapm.118271

Cited by 8 publications

(7 citation statements)

References 66 publications

(92 reference statements)

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“…In another study, it was found that combining dexmedetomidine with clonidine is effective in lowering intraoperative bleeding ( 36 ). Some studies suggest that the use of dexmedetomidine, a selective α-2 antagonist, reduces the incidence of cognitive impairment and delirium in mechanically ventilated patients ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

2022

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Background: Dilatation and curettage (D & C) is one of the relatively common surgeries among women. Familiarity with the analgesics, along with their different uses and specific characteristics, can help to determine the best and most appropriate drug to control pain in the patients. Objectives: This study aimed to compare the effects of ketofol, dexmedetomidine, and isofol in anesthesia of candidates for D & C. Methods: In this double-blind clinical trial, 150 candidates for D & C surgeries with ASA class 1 and 2 were included. Patients were randomly divided into three groups. The first group received ketamine + propofol, the second group received dexmedetomidine, and the third group received isofol (isoflurane + propofol). Any hemodynamic changes or respiratory disorders, including apnea or hypoventilation, drop in the level of blood oxygen saturation, and the need for respiratory support, were recorded and compared. Results: Hypoventilation was observed in 47 patients in isofol group, 18 in the dexmedetomidine group, and 42 in ketofol group. Also, 48 patients in the isofol group, eight in the dexmedetomidine group, and 33 in the ketofol group experienced apnea. Moreover, 17 patients in the dexmedetomidine group, 35 in the ketofol group, and eight in the isofol group experienced bradycardia. The rate of bradycardia was significantly higher in the dexmedetomidine group (70%) compared to the other two groups, and the rate of hypotension was significantly higher in the isofol group (P = 0.001). Conclusions: According to the results, dexmedetomidine was associated with fewer complications during general anesthesia in D & C surgery.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

2022

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“…Pharmacological agents (not in the order of preference) include etomidate, propofol, and midazolam fentanyl, remifentanil, ketamine, dexmedetomidine, and many others either alone or combined ( 21 ). A recent literature review suggests that dexmedetomidine sedation for ophthalmic surgery under local / regional anesthesia is potentially useful, but its role may be limited due to logistical difficulties in administering the recommended dose ( 22 ). There is not much difference among the groups, but propofol appears superior to the other two agents ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Vitreoretinal Surgery Under Sub-Tenon’s Block and Conscious Sedation in a Patient with Brugada Syndrome: A Case Report and Literature Review

et al. 2021

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: Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.

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“…While DEX is mainly utilized in intensive care units due to its demonstrated suitability for achieving both short- and longer term sedation [ 1 , 2 ], it has more recently been applied in conjunction with local anesthesia in various surgical fields due to its minimal effects on respiratory depression. Several studies have noted that incorporating DEX into the regimen can induce light intraoperative sedation, which can help alleviate the fear of surgery in patients undergoing ophthalmological procedures [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Epiretinal Membrane Surgery for a Patient with Dyskinesia Related to Parkinson’s Disease Using Intravenous Dexmedetomidine Administration

Suzuki

Sasajima

Ueta

et al. 2022

Case Rep Ophthalmol

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General anesthesia is usually selected when patients cannot remain still during surgery with local anesthesia. However, damage to the lungs from positive pressure ventilation under general anesthesia is a major concern in patients with Parkinson’s disease. We report a case in which dyskinesia related to Parkinson’s disease was attenuated by intravenous dexmedetomidine (DEX) administration, following which epiretinal membrane (ERM) and inner limited membrane peeling could be smoothly performed. A 68-year-old woman with systemic dyskinesia related to Parkinson’s disease underwent cataract surgery for her right eye with local anesthesia (topical anesthesia with 4% lidocaine and sub-Tenon’s anesthesia with 2% lidocaine and 30% nitrous oxide inhalation). During the surgery, continuous involuntary facial movement related to Parkinson’s disease remained uncontrollable. One week later, she underwent cataract surgery and pars plana vitrectomy for the ERM of her left eye. In addition to local anesthesia (topical anesthesia with 4% lidocaine and retrobulbar anesthesia with 2% lidocaine and 30% nitrous oxide inhalation), the patient received intravenous DEX, which halted movement from the beginning of surgery until the end. Therefore, ERM surgery was performed without the influence of dyskinesia. This case highlights that intravenous DEX administration can inhibit dyskinesia related to Parkinson’s disease during ERM surgery, which is among the most delicate microscopic procedures performed in ophthalmological settings. Additional studies are required to examine the actual effectiveness of DEX administration in patients with Parkinson’s disease-related dyskinesia undergoing ophthalmological procedures.

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Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

Cited by 8 publications

References 66 publications

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

Vitreoretinal Surgery Under Sub-Tenon’s Block and Conscious Sedation in a Patient with Brugada Syndrome: A Case Report and Literature Review

Epiretinal Membrane Surgery for a Patient with Dyskinesia Related to Parkinson’s Disease Using Intravenous Dexmedetomidine Administration

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