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Eom Y, Koh E, Lee DH, Lee SJ, Nam DH. Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope. J Cataract Refract Surg 2023; 49:1036-1042. [PMID: 37440456 DOI: 10.1097/j.jcrs.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. SETTING 4 tertiary institutions in Korea. DESIGN Prospective, randomized, paired-eye, controlled pilot study. METHODS 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. RESULTS The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. CONCLUSIONS Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.
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Affiliation(s)
- Youngsub Eom
- From the Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea (Eom); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Eom); Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia (Eom); Medical College of Georgia, Augusta University, Augusta, Georgia (Koh); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea (S.J. Lee); Department of Ophthalmology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, South Korea (Nam)
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Korkmaz S, Kaderli A, Kaderli ST, Sul S, Karalezli A. Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery. Int Ophthalmol 2023:10.1007/s10792-023-02657-7. [PMID: 36877317 DOI: 10.1007/s10792-023-02657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate. METHODS Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020 years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods. RESULTS Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4 min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027). CONCLUSIONS Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.
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Affiliation(s)
- Safak Korkmaz
- Ophthalmology, Faculty of Medicine, Giresun University, Giresun, Turkey.
| | - Ahmet Kaderli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Sema Tamer Kaderli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Sabahattin Sul
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Aylin Karalezli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
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Dang A, Reddy AJ, Pokala V, Rabara J, Brahmbhatt H. An Analysis of the Use of Proparacaine in Cataract Surgery. Cureus 2022; 14:e22175. [PMID: 35308736 PMCID: PMC8923310 DOI: 10.7759/cureus.22175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
A cataract is the primary cause of preventable blindness and is characterized by a congenital, developmental, or acquired opacity of the human lens. Cataracts are predominantly treated through surgical procedures utilizing a combination of anesthetic agents such as proparacaine to reduce patient discomfort. Proparacaine is used to inhibit voltage-gated sodium channels on neuronal membranes to prevent signal propagation and pain signaling in the patient. Current clinical standards call for the utilization of 0.5% proparacaine when used for local anesthesia in cataract surgeries. In this review, the authors extracted the reported application site and concentrations of proparacaine in conjunction with various combination agents to accurately describe its usage in cataract surgery. It was found that most surgeons adhered to the standard concentrations of proparacaine and generally used tropicamide, an eye dilator, as a combination agent in cataract surgery. Additionally, surgeons preferred anesthetic application to the retrobulbar block. The authors find that although surgeons are following standard protocol, adjustments for lowering the standard dose of proparacaine could prove beneficial in preventing proparacaine toxicity. Furthermore, the authors find that more research can be conducted in the future examining other combination agents for use with proparacaine to improve patient outcomes.
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Kumar CM, Chua AWY, Imani F, Sehat-Kashani S. Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review. Anesth Pain Med 2021; 11:e118271. [PMID: 34692445 PMCID: PMC8520679 DOI: 10.5812/aapm.118271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 01/28/2023] Open
Abstract
Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Alfred W. Y. Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saloome Sehat-Kashani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Zhu X, Lu Q, Yao Y, Xu X, Lu Y. Intraoperative Pain Sensation During Cataract Surgery: Why Does Timing Matter? Curr Eye Res 2020; 46:971-977. [PMID: 33249933 DOI: 10.1080/02713683.2020.1857776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.Methods: Patients scheduled for cataract surgery both in the morning and afternoon were consecutively enrolled. Questionnaires to evaluate anxiety, including the Simplified State-Trait Anxiety Inventory, Amsterdam Preoperative Anxiety and Information Scale, and a visual analogue scale (VAS) for anxiety, were completed preoperatively, whereas a VAS for pain and the Wong-Baker FACES® Pain Rating Scale questionnaire were completed after surgery. Preoperative blood pressure and heart rate were recorded. Blood samples were acquired before surgery, and plasma cortisol, adrenocorticotropic hormone, adrenalin, and noradrenalin were tested.Results: Fifty-five patients underwent uneverntful cataract surgery (28 in the morning and 27 in the afternoon) were included in the final analysis. Greater intraoperative pain perception during cataract surgery was reported in the afternoon than in the morning. Overall anxiety levels were significantly higher in the afternoon. Plasma adrenalin levels were significantly higher in the afternoon. Cortisol levels were higher in the afternoon. Preoperative anxiety levels were closely related to intraoperative pain perception. Both adrenalin and cortisol correlated positively with preoperative anxiety, but only adrenalin correlated significantly with the pain scores.Conclusions: Patients undergoing cataract surgery in the afternoon showed more preoperative anxiety, which may have increased their relevant stress hormones. Both the patient's emotional state and hormone levels may together aggravate his/her perceived pain in the afternoon. Monitoring preoperative anxiety levels, blood pressure, and heart rate should help to identify patients at higher risk of perceived intraoperative pain.Clinical trial registration:Trial registration number: NCT02182921Registration site: clinicaltrials.gov.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qiang Lu
- Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yunqian Yao
- Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China
| | - Xujiong Xu
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Yi Lu
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
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Jones JH, Aldwinckle R. Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review. BMC Anesthesiol 2020; 20:75. [PMID: 32247310 PMCID: PMC7126406 DOI: 10.1186/s12871-020-00973-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
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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Affiliation(s)
- James Harvey Jones
- UC Davis Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
| | - Robin Aldwinckle
- UC Davis Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
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Assam JH, Bernhisel A, Lin A. Intraoperative and postoperative pain in cataract surgery. Surv Ophthalmol 2018; 63:75-85. [DOI: 10.1016/j.survophthal.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
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Ter Bruggen FFJA, Eralp I, Jansen CK, Stronks DL, Huygen FJPM. Efficacy of Dexmedetomidine as a Sole Sedative Agent in Small Diagnostic and Therapeutic Procedures: A Systematic Review. Pain Pract 2016; 17:829-840. [PMID: 27862903 DOI: 10.1111/papr.12519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/07/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
Dexmedetomidine is an upcoming agent with sedative, anxiolytic, and analgesic properties. This review summarizes empirical evidence for the efficacy of dexmedetomidine as a sole sedative agent, and its effectiveness for small diagnostic and therapeutic procedure, in comparison with other frequently used sedatives. All randomized controlled trials on the effect of dexmedetomidine were reviewed. Pain level, patient satisfaction, operator satisfaction, procedure duration, recovery time, and hemodynamic and respiratory characteristics were examined. A total of 1993 patients (1,621 adults; 372 children) from 35 studies were included. In the adult studies, dexmedetomidine yielded significantly lower pain levels compared to the other sedatives (in 31.25% of the included studies) and significantly more patient satisfaction (68.2%). In studies on children, more favorable results concerning respiratory safety and the level of adequate sedation were found compared to the control sedatives. Implications for future studies are discussed.
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Affiliation(s)
| | - Ismail Eralp
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Chris K Jansen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk L Stronks
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands
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Dadacı Z, Borazan M, Öncel Acır N. Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain. Turk J Ophthalmol 2016; 46:151-155. [PMID: 28058148 PMCID: PMC5200818 DOI: 10.4274/tjo.13914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/04/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain. MATERIALS AND METHODS Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient. RESULTS Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05). CONCLUSION Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort.
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Affiliation(s)
- Zeynep Dadacı
- Mevlana University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Mehmet Borazan
- Mevlana University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Nurşen Öncel Acır
- Mevlana University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
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Cinaroglu S, Hearld KR, İgici SO. Explanatory Factors of Quality of Care from Cataract Patients’ Perspectives. Semin Ophthalmol 2016; 32:321-325. [DOI: 10.3109/08820538.2015.1088553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Hacettepe University, Beytepe Campus, Ankara, Turkey
| | - Kristine Ria Hearld
- Department of Health Services Administration, University of Alabama, Birmingham, AL, USA
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Yoo JH, Kim SI, Cho A, Lee SJ, Sun HJ, Cho HB, Lee DR. The effect of dexmedetomidine sedation on patient and surgeon satisfaction during retinal surgery under sub-tenon's anesthesia: a randomized controlled trial. Korean J Anesthesiol 2015; 68:442-8. [PMID: 26495053 PMCID: PMC4610922 DOI: 10.4097/kjae.2015.68.5.442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to evaluate the effect of intraoperative dexmedetomidine sedation on patient's and surgeon's satisfaction during retinal surgery under sub-tenon's anesthesia. Methods Forty-four patients scheduled for elective retinal surgery under sub-tenon's anesthesia were enrolled in this randomized controlled trial. The patients were divided into Dexmedetomidine (n = 22) and Control (n = 22) groups. Intravenous dexmedetomidine or 0.9% saline via infusion pump were administered continuously to the dexmedetomidine or control group, respectively. Ramsay sedation scale with a target level of 3-4 was used to assess adequacy of sedation. Perioperative pain, hemodynamic and respiratory data were collected, while satisfaction from patients and surgeon were assessed post-surgery using a 5-point satisfaction scale. Results Patient and surgeon satisfaction was higher in the dexmedetomidine group (P < 0.001, P = 0.002, respectively). The pain associated with sub-tenon's anesthesia and peripheral vitrectomy was lesser in the dexmedetomidine group than in the control group (P = 0.020). There was significant reduction of heart rate in the dexmedetomidine group (P = 0.001), but only one patient needed treatment with atropine. There was no respiratory effect on both groups. Conclusions Dexmedetomidine sedation during retinal surgery improved satisfaction from both patient and surgeon without respiratory complication. It is a safe and preferable choice of sedation for retinal surgery.
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Affiliation(s)
- Jae-Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Soon Im Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ana Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hae Jung Sun
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Dong Ryun Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Kassir M, Kassas MC, Ajine M, Hammoud M, Mahmoud W. [Role of deep sedation phacoemulsification with scleral tunnel]. J Fr Ophtalmol 2015; 38:752-7. [PMID: 26341020 DOI: 10.1016/j.jfo.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a method of deep sedation without adjunctive periocular injection in phacoemulsification with a scleral tunnel technique. METHODS All patients undergoing phacoemulsification with a scleral tunnel and foldable intraocular lens for cataract between May 2011 and November 2014 received deep sedation including a bolus of midazolam and fentanyl followed by a continuous perfusion of dexmedetomidine throughout the surgical procedure. The patients and medical team evaluated pain, sedation, clinical status of the patient, and surgeon comfort. RESULTS One thousand and five hundred patients were included, representing 1763 eyes. Ramsay's sedation score was 2 in 7.13% of cases and 3 in 86.3%, which allowed surgery to be performed under very satisfactory conditions. On a scale of 1 to 10, intraoperative pain was less than or equal to 1 in 81.2% of cases. The bradycardic and hypotensive effects of dexmedetomidine were appreciable, while respiratory depression was not observed. Only 1 case of severe agitation during surgery directly resulted in a vitreous issue. Some simple precautions allow optimization of the advantages of this method of anesthesia. CONCLUSION The deep sedation method including bolus injections of midazolam and fentanyl and continuous perfusion of dexmedetomidine affords a certain comfort to the patient as well as the surgeon in phacoemulsification of cataract through a scleral tunnel without adjunctive periocular injection.
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Affiliation(s)
- M Kassir
- Service d'ophtalmologie, Labib Medical Centre, rond-point ELIA, immeuble Dandachli Plaza, BP 644, Saïda, Liban.
| | - M C Kassas
- Service d'anesthésie-réanimation, Victoria Hospital, Riyad, Arabie Saoudite; Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - M Ajine
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - M Hammoud
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - W Mahmoud
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
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Ghodki PS, Sardesai SP, Halikar SS. Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1028225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Park SH, Shin YD, Yu HJ, Bae JH, Yim KH. Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia. Korean J Anesthesiol 2014; 66:371-6. [PMID: 24910729 PMCID: PMC4041956 DOI: 10.4097/kjae.2014.66.5.371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/11/2013] [Accepted: 11/21/2013] [Indexed: 12/30/2022] Open
Abstract
Background As the number of elder patients grows, spinal anesthesia for such patients are increasing significantly. Any effort is needed to use the least anesthetic drug for maintaining the anesthesia while avoiding hazards of cardio-pulmonary complications. Methods American Society of Anesthesiologists physical status classification I and II, Forty five elderly patients (≥ 60 years) who received transurethral resection of the prostate or transurethral resection of the bladder tumor were allocated randomly into three treatment groups. The DMT 0.5 group was designed as with dexmedetomidine 0.5 µg/kg while the DMT 1.0 group has a 1 µg/kg intravenous injection over 10 min before anesthetic induction. The Control group was designed to get a normal saline. Each group was compared regarding the maximum sensory block level, extension of anesthesia, degree of motor block, level of sedation, VAS score and complications. Results There were no significant differences among the 3 treatment groups regarding the maximum level of sensory block and motor block. However, the duration of sensory block was significantly longer in DMT 1.0 group than in the control group (P = 0.045). Both DMT 1.0 group (median = 3, range = 2-6) and DMT 0.5 group (median = 3, range = 1-6) showed a mean value of 3-4 Ramsay sedation score, which resulted in more excessive sedation and significantly greater incidence of bradycardia compared to the control group. No complications such as hypotension, nausea, tremor, and hypoxia were found during this investigation. Conclusions In elder patients, the DMT 1.0 group is effective in duration of sensory block and is superior in the aspect of prolonged duration of sensory block compared to the DMT 0.5 group.
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Affiliation(s)
- Sang Hi Park
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Jeong Yu
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jin Ho Bae
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyoung Hoon Yim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Seo HW, Choi SK, Lee DH, Kim JH. The Effects of Conjunctival Shield on Pain Alleviation During Cataract Surgery in Conjunctivochalasis Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hae Won Seo
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | | | - Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
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Abstract
Purpose To 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. Methods A 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). Results Nine 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. Conclusion When 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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Affiliation(s)
- Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon ; Rafik Hariri University Hospital, Beirut, Lebanon
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Dogan R, Karalezli A, Sahin D, Gumus F. Comparison of sedative drugs under peribulbar or topical anesthesia during phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2012; 43:121-7. [PMID: 22320409 DOI: 10.3928/15428877-20120102-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 01/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare dexmedetomidine and midazolam+fentanyl sedation primarily based on patient satisfaction during phacoemulsification under topical and peribulbar anesthesia. PATIENTS AND METHODS Prospective, randomized, and double-blind study of 80 American Society of Anesthesiology grade I-II patients who underwent phacoemulsification with local anesthesia under sedation. Patients were divided into four groups (20 patients for each): dexmedetomidine and topical anesthesia, dexmedetomidine and peribulbar anesthesia, midazolam+fentanyl and topical anesthesia, and midazolam+fentanyl and peribulbar anesthesia. Patient and surgeon satisfaction were determined on a 5-point scale. The pain was determined by verbal pain scale intraoperatively and postoperatively. Drugs were given to a Ramsay sedation scale of 3. Topical and peribulbar anesthesia were performed by an ophthalmologist. Hemodynamic, respiratory, and intraocular pressure monitoring was done. Operative and recovery times were recorded. RESULTS In the midazolam+fentanyl groups, better patient and surgeon satisfaction scores were obtained (P < .005), verbal pain scale scores were significantly lower (P < .001), and patients needed less postoperative analgesia. Ramsay sedation scale scores were between 3 and 4 in all patients and there were no significant differences. Intraocular pressure alterations were similar between groups. Recovery time was longer in the dexmedetomidine groups (P < .05). CONCLUSION The study demonstrated that the midazolam+fentanyl combination provided high-level patient satisfaction scores, low-level pain scores, and shorter recovery time. Also, both of the peribulbar and topical anesthesia procedures showed similar efficiency.
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Affiliation(s)
- Rafi Dogan
- Anesthesiology Department, Baskent University, Ankara, Turkey
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Comparison of local anaesthesia with dexmedetomidine sedation and general anaesthesia during septoplasty. Eur J Anaesthesiol 2011; 27:960-964. [PMID: 20498606 DOI: 10.1097/eja.0b013e32833a45c4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare general anaesthesia and local anaesthesia with dexmedetomidine on the basis of postoperative pain and surgical bleeding after septoplasties. METHOD Sixty patients with ASA 1 or 2 were divided into the local anaesthesia with dexmedetomidine (LAD) group (n = 30) and the general anaesthesia group (n = 30). Heart rate (HR), SBP and DBP were monitored. The amount of surgical bleeding, duration of surgery and recovery, postoperative pain evaluations [by visual analogue scale (VAS)] and nausea-vomiting were also recorded. Patients' satisfaction with anaesthesia and quality of breathing was questioned 1 week after discharge. RESULTS HR values were significantly higher in the general anaesthesia group than in the LAD group at the 15th min and at the end of surgery. The SBP value at the 30th min was significantly higher in the LAD group than in the general anaesthesia group. No difference was observed between the groups with respect to the DBP value. Surgical bleeding and the duration of recovery were significantly less in the LAD group. The postoperative VAS scores were significantly higher in the general anaesthesia group than in the LAD group. Postoperative nausea-vomiting was also significantly greater in the general anaesthesia group. Although more patients in the LAD group preferred this anaesthetic procedure to general anaesthesia, the quality of breathing was better in both groups after surgery. CONCLUSION Septoplasty performed under local anaesthesia with dexmedetomidine sedation resulted in less surgical bleeding, less postoperative pain, a more stable haemodynamic state, less nausea-vomiting, a shorter recovery period and a higher level of anaesthesia satisfaction.
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Makary L, Vornik V, Finn R, Lenkovsky F, McClelland AL, Thurmon J, Robertson B. Prolonged Recovery Associated With Dexmedetomidine When Used as a Sole Sedative Agent in Office-Based Oral and Maxillofacial Surgery Procedures. J Oral Maxillofac Surg 2010; 68:386-91. [DOI: 10.1016/j.joms.2009.09.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/16/2009] [Accepted: 09/23/2009] [Indexed: 10/19/2022]
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Current world literature. Curr Opin Anaesthesiol 2009; 22:447-56. [PMID: 19417565 DOI: 10.1097/aco.0b013e32832cbfed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 February 2008 and 31 January 2009 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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