Assessing intravenous midazolam for conscious sedation during cataract surgery

Background: A large number of geriatric populations above the age of 50 worldwide suffer from cataract. Cataract starts with short-sightedness and gradually worsens resulting in blurring of vision and inability to visualize and distinguish fine details. Surgery is the only available treatment for cataract. Anaesthesia is essential during cataract surgery to minimize pain caused during surgical procedure and to achieve favourable surgical outcome. The current investigation was aimed towards assessing the performance of intravenous midazolam used for conscious sedation during cataract surgery along with retrobulbar block.Methods: Current study is a randomized double blinded study performed for duration of 6 months on 60 patients undergoing cataract surgery at Terna medical college and hospital. Patients were divided in two groups; group M received 0.02 mg/kg midazolam diluted to 5 ml, group N received 5 ml normal saline before cataract surgery. All vital hemodynamic parameters were observed after 5 minutes of sedation, immediately after block administration and after every 15 minutes till the end of the surgery to assess the effect of sedation. Patients and surgeons satisfaction levels were also documented post-surgery.Results: Patients who were sedated with midazolam prior to cataract surgery along with block exhibited a significant decrease in hemodynamic parameters like SAP, DAP and heart rate which indicated effective sedation. Anxiety level also significantly decreased in the patients who received midazolam. No major adverse or intra-operative events were observed in the patients who received midazolam.Conclusions: Sedation with midazolam provides haemodynamic conditions favourable for cataract surgery along with high level of patient and surgeon satisfaction.

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Comparative study between the effect of intrathecal bupivacaine versus bupivacaine dexmedetomidine combination in spinal anaeshtesia for lower abdominal surgeries

QJM ◽

10.1093/qjmed/hcab086.077 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mervat M Marzouk ◽

Wael R Thabet ◽

Tarek M Ashoor ◽

Ahmed Morsy Ahmed

Keyword(s):

Blood Pressure ◽

Spinal Anaesthesia ◽

Primary Outcome ◽

Sensory Block ◽

University Hospital ◽

Rescue Analgesia ◽

Blinded Study ◽

Hospital Patients ◽

Block Level ◽

Double Blinded

Abstract Study objectives We compared effect of intrathecal bupivacaine versus bupivacaine Design This is a prospective, randomized, double-blinded study. Setting The setting is at an operating room in Ain Shams University Hospital. Patients: 50 patients scheduled for general anesthesia were randomly allocated to the following 2 groups in equal numbers. Interventions Spinal anaesthesia will be performed in the sitting position at L3-L4 or L4-L5 level using a 25-gauge Quincke spinal needle by the most competent experts. The sensory block level will be assessed along the mid-clavicular line bilaterally. The motor block will be assessed according to Bromage scale Measurements Post operative (VAS) score and Time to first requested analgesia.(primary outcome), Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate will be recorded every 5 minutes for 20 minutes then every 15 minutes till the end of surgery, Nausea and/ or vomiting as yes/no, Level of highest sensory block, Bromage score ≥3, Onset of sensory block and Two segment regression time (secondary outcomes) were recorded.. Main results Results of this study showed that the addition of dexmedetomidine to bupivacaine in spinal anaesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia and lower NRS scores with minimal adverse effects and haemodynamic stability. Conclusions We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower abdominal surgeries.

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Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

Saudi Journal of Ophthalmology ◽

10.1016/j.sjopt.2018.02.013 ◽

2018 ◽

Vol 32 (3) ◽

pp. 204-210 ◽

Cited By ~ 1

Author(s):

Nagarajan Swathi ◽

K. Srikanth ◽

S. Venipriya

Keyword(s):

Cataract Surgery ◽

Blinded Study ◽

Peribulbar Anesthesia ◽

Double Blinded

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Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/604 ◽

2021 ◽

Vol 8 (37) ◽

pp. 3328-3333

Author(s):

Sumeet Deshpande ◽

Rashmi R. Anwekar ◽

Rajashree Reddy

Keyword(s):

Cataract Surgery ◽

High Volume ◽

Topical Anaesthesia ◽

Small Incision Cataract Surgery ◽

Mild Pain ◽

Medical College ◽

Small Incision ◽

Peribulbar Anaesthesia ◽

Significant Difference ◽

Surgeon Satisfaction

BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia

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