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Rhee J, Vazquez R, Ma H. Pro-Con Debate: Judicious Benzodiazepine Administration for Preoperative Anxiolysis in Older Patients. Anesth Analg 2023; 137:280-288. [PMID: 37450906 PMCID: PMC10358369 DOI: 10.1213/ane.0000000000006337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this Pro-Con commentary article, we discuss the risks and benefits of administering preoperative benzodiazepines to older patients to decrease preoperative anxiety. The Pro side first focuses on the critical importance of treating preoperative anxiety and that benzodiazepines are the best tool to achieve that goal. The competing argument presented by the Con side is that myriad options exist to treat preoperative anxiety without simultaneously increasing the risk for devastating complications such as postoperative delirium. Both sides call for more high-quality investigations to determine the most effective strategies for decreasing preoperative anxiety in older adults while improving outcomes and reducing morbidity.
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Affiliation(s)
- James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Ono T, Iwasaki T, Kawahara K, Agune Y, Mori Y, Nejima R, Aihara M, Miyata K. Early intervention for perioperative hypertension in cataract surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:147-154. [PMID: 36029304 DOI: 10.1007/s00417-022-05815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/07/2022] [Accepted: 08/19/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia. METHODS Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation. RESULTS Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use. CONCLUSION Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.
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Affiliation(s)
- Takashi Ono
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan.
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takuya Iwasaki
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Kana Kawahara
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yuko Agune
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yosai Mori
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Ryohei Nejima
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunori Miyata
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
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Agrawal A, Rathi NV, Thosar NR. A Comparative Evaluation of the Anxiolytic Effect of Oral Midazolam and a Homeopathic Remedy in Children During Dental Treatment. Cureus 2022; 14:e31041. [DOI: 10.7759/cureus.31041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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Loong LJ, Ling KK, Tai ELM, Kueh YC, Kuan G, Hussein A. The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:10194. [PMID: 36011825 PMCID: PMC9408317 DOI: 10.3390/ijerph191610194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.
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Affiliation(s)
- Ling Jiunn Loong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Koh Koon Ling
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Evelyn Li Min Tai
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Garry Kuan
- Exercise and Sports Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Adil Hussein
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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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] [What about the content of this article? (0)] [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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Wang Y, Xu W, Xia W, Wei L, Yang D, Deng X, Yan F. Comparison of the Sedative and Analgesic Effects of Dexmedetomidine-Remifentanil and Dexmedetomidine-Sufentanil for Liposuction: A Prospective Single-Blind Randomized Controlled Study. Aesthetic Plast Surg 2022; 46:524-534. [PMID: 34499193 DOI: 10.1007/s00266-021-02566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dexmedetomidine had sedative and analgesic effects and did not produce significant respiratory depression at therapeutic doses. AIMS To compare the sedative and analgesic effects and safety of dexmedetomidine combined with remifentanil or sufentanil in patients undergoing liposuction. METHODS A total of 100 subjects were randomized 1:1 to two groups: Group R and Group S. First, patients were administered midazolam 0.02 mg·kg-1. Anesthesia was induced with an intravenous infusion of dexmedetomidine 1 µg kg-1 (15 min) and remifentanil 0.1 µg kg-1 min-1 (Group R) or sufentanil 0.1 µg kg-1h-1 (Group S). Anesthesia was maintained with an intravenous infusion of dexmedetomidine 1.0 µg kg-1h-1, midazolam 0.015 mg kg-1h-1, remifentanil 0.1 µg kg-1min-1 (Group R), or sufentanil 0.1 µg kg-1h-1 (Group S). Hemodynamic and respiratory changes, modified OAA/S score and BIS values, postoperative Visual Analogue Scale pain scores, satisfaction of the patient and surgical team with the procedure, and adverse events and recovery time were recorded. RESULTS Group R received significantly less midazolam and midazolam per hour compared to Group S (Group R vs. Group S: 3.4 ± 1.7 mg vs. 5.1 ± 2.0 mg, P < 0.0001; 1.5 ± 0.7 mg/h vs. 1.9 ± 0.6 mg/h, P = 0.002). The incidence of physical or verbal expressions of pain at the start of surgery was significantly lower in Group R compared to Group S (2 [4.3%] vs. 12 [26.7%], P = 0.003). Patient satisfaction with the procedure was significantly higher in Group R compared to Group S (3.9 ± 0.3 vs. 3.1 ± 0.3, P < 0.0001). CONCLUSION Dexmedetomidine-remifentanil and dexmedetomidine-sufentanil were effective and safe sedative and analgesic agents for liposuction. Hemodynamic stability was maintained. Dexmedetomidine-remifentanil might be associated with improved analgesic effects compared to dexmedetomidine-sufentanil. LEVEL OF EVIDENCE II Evidence was obtained from at least one properly designed randomized controlled trial. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ye Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China
| | - Wenli Xu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China
| | - Weipeng Xia
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China
| | - Lingxin Wei
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China.
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shijingshan District, Beijing, 100144, China.
| | - Fuxia Yan
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Venkatesh R, Kenia H, Sengupta S, Gopalakrishna M, Au Eong KG. Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: A randomized controlled trial. Adv Ophthalmol Pract Res 2021; 1:100006. [PMID: 37846396 PMCID: PMC10577815 DOI: 10.1016/j.aopr.2021.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/19/2021] [Accepted: 09/05/2021] [Indexed: 10/18/2023]
Abstract
Purpose Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: a randomized controlled trial. Design Prospective, double masked, randomized controlled trial. Methods 150 eyes of 150 patients undergoing phacoemulsification and IOL implantation under topical anesthesia were randomized to receive either intravenous midazolam (0.015 mg/kg) or normal saline. The patients' experience was evaluated using a questionnaire. Vital signs including blood pressure and heart rate were measured before, during and after surgery. Mean arterial pressure (MAP) was calculated. Results Both groups were comparable except that fewer patients in the control group were pseudophakic in the fellow eye (25.3% vs. 41.3%). More patients in the control group perceived hand movements (p < 0.01), surgeon/medical staff (p = 0.04) and sudden increase in vision during surgery (p < 0.01) compared to midazolam group. More control group patients experienced fear (p < 0.001), pain (p = 0.06) and unpleasant surgical experience (20.3% vs. 1.3%, p < 0.001). They also experienced greater fluctuation in MAP (16.9 ± 7.9 vs.7.2 ± 5.3, p < 0.001) and this was accentuated in hypertensives. After adjusting for age, gender, hypertension status and other eye lens status, multivariable logistic regression analysis revealed that subjects in the control arm (OR = 11.7, 95% [CI] = 1.3-108, p = 0.03), had a longer duration of surgery, experienced pain and more likely to report unpleasant experience. Adjusting for similar covariates, multivariable linear regression analysis showed that control group patients (β = 8.5 mmHg, 95% CI = 6.2-10.8, p = 0.03) had hypertension, experienced fear during surgery and greater fluctuations in the MAP. Conclusions A sedative dose of intravenous midazolam during phacoemulsification under topical anesthesia significantly reduces patients' visual experience, fear and fluctuations in MAP and improves overall surgical experience.
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Affiliation(s)
| | | | | | | | - Kah-Guan Au Eong
- International Eye Cataract Retina Center, Mount Elizabeth Medical Center and Farrer Park Medical Center, Singapore
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Obuchowska I, Konopinska J. Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review. Psychol Res Behav Manag 2021; 14:781-793. [PMID: 34177276 PMCID: PMC8219311 DOI: 10.2147/prbm.s314214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.
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Affiliation(s)
- Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
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Sriramka B, Mallik D, Singh J, Khetan M. Effect of hand-holding and conversation alone or with midazolam premedication on preoperative anxiety in adult patients-A randomised controlled trial. Indian J Anaesth 2021; 65:128-132. [PMID: 33776087 PMCID: PMC7983819 DOI: 10.4103/ija.ija_705_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/26/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Anxiety causing stress is most profound before surgery. Anxiolytics are used routinely to combat perioperative anxiety. Studies have shown that hand-holding and communication are useful in reducing anxiety levels intraoperatively. This study compares the effectiveness of the same with pharmacological interventions in allaying preoperative anxiety. Material and Methods: This is a three-arm parallel-group randomised controlled trial. A total of 90 adult patients aged <45 years and of American Society of Anesthesiologists (ASA) grade 1–2, undergoing laparoscopic surgery were enroled in this study. Patients received either intravenous (IV) midazolam (group M) or hand-holding and conversation (group HC), or a combination of IV midazolam and holding and conversation (group HCM) in the preoperative room. Anxiety, heart rate (HR) and mean blood pressure (MBP) were recorded before and 20 minutes after the intervention. Anxiety was measured using the Amsterdam preoperative anxiety and information scale. The analysis of covariance (ANCOVA) test was done to analyse the difference between the groups. Results: The mean anxiety scores were significantly different in the three groups (p = 0.04) after intervention, with the lowest score in group HCM, followed by group HC and the highest score in group M. The mean heart rates were also significantly different in the three groups after intervention but MBP was not significantly different in the three groups. Conclusion: A combination of hand-holding and conversation and midazolam is best for allaying preoperative anxiety in patients undergoing laparoscopic surgeries than either method alone.
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Affiliation(s)
- Bhavna Sriramka
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Diptimayee Mallik
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Jayanti Singh
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Megha Khetan
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
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Heard JA, Zacarias AAG, Lawrence AT, Stoicea N, Palettas M, Fiorda-Diaz J, Guertin MG, Tandon A, Lowery DS. A prospective observational cohort study to evaluate patients' experience during sequential cataract surgery under monitored anesthesia care and topical anesthesia. Medicine (Baltimore) 2020; 99:e21834. [PMID: 33217786 PMCID: PMC7676552 DOI: 10.1097/md.0000000000021834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract surgery is the most common ambulatory surgery at our outpatient surgery center. Several studies have shown that patients with bilateral cataracts may experience different levels of anxiety, pain, and awareness during the first and second cataract extraction.A prospective observational cohort study was conducted at The Ohio State University Wexner Medical Center Eye and Ear Institute in order to compare anxiety, general comfort, awareness, and pain levels in patients undergoing sequential cataract surgeries. Likert and numerical rating scale were used to assess the outcomes. Patients receiving monitored anesthesia care and topical anesthesia were included.A total of 198 patients were enrolled in this study, 116 patients (59%) were female and 157 patients (78%) were Caucasians with a median age of 67 years among participants. Patients with rating "no anxiety" or feeling "somewhat anxious" were significantly higher during surgery 2 (P =< .001). Most of the patients felt "extremely comfortable" during surgery 1 when compared to surgery 2 (54% vs 42.9%; P = .08). No significant differences were found between surgeries regarding intraoperative awareness (P = .16). Overall, patients experienced mild pain during both procedures (92.4% in surgery 1 compared to 90.4% in surgery 2; P = .55). During the postoperative visit, 54% of the patients associated surgery 2 with less anxiety levels, 53% with no differences in general comfort, 60% felt more aware, and 59% had no differences in pain levels.Previous exposure to surgery could have been associated with a significant reduction in anxiety levels reported during surgery 2. Non-pharmacological strategies aiming to reduce perioperative anxiety may be considered an alternative or additional approach to premedication in patients undergoing consecutive cataract surgeries.
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Affiliation(s)
| | | | | | | | | | | | | | - Amit Tandon
- Department of Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH
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Dickson D, Padilla Conde T, Berdahl J, Osmundson G, Sudhagoni R, Bender C, Thompson V, Berdahl J. Comparison of a new sublingual sedation troche with midazolam, ketamine, and ondansetron with intravenous sedation and the effects on vital signs. J Cataract Refract Surg 2020; 46:1037-40. [PMID: 32352253 DOI: 10.1097/j.jcrs.0000000000000211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare effects of the MKO Melt (midazolam 3 mg, ketamine 25 mg, and ondansetron 2 mg) with intravenous (IV) sedation on vital signs of patients who underwent cataract surgery. SETTING Two private ophthalmology practices in Sioux Falls, South Dakota, USA. DESIGN Retrospective analysis. METHODS Preoperative, intraoperative, and postoperative vital signs were compared between individuals who underwent cataract surgery and received exclusively either MKO (n = 991) or traditional IV methods (n = 120) for sedation. Clinical significance was defined as a 5 mm Hg change in blood pressure, 3 beats per minute (bpm) change in heart rate, a change of 2 respirations per minute, or a change of 3% in O2 saturation. MKO Melt but not IV sedation was given before the reported preoperative vital signs. RESULTS There were 1111 patients included in this study. Preoperative systolic blood pressure (SBP) was 133.7 ± 15.6 mm Hg in the MKO group and 139.6 ± 17.3 mm Hg in the IV group (P = .0001). Postoperative SBP was 130.8 ± 12.9 mm Hg in the MKO group and 135.8 ± 19.3 mm Hg in the IV group (P < .01). Postoperative heart rate was 66.3 ± 10.4 bpm in the MKO group compared with 69.8 ± 10.5 bpm in the IV group (P < .001). No other clinically and statistically significant differences were found. The mean number of melts used was 1.5. CONCLUSIONS Clinically and statistically significant improvements in preoperative and postoperative SBP and postoperative heart rate were observed in patients who received MKO Melt. The MKO Melt was safe, effective, and well tolerated and a viable alternative to IV sedation.
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Kumar CM, Seet E, Eke T, Irwin MG, Joshi GP. Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review. Anaesthesia 2019; 74:1601-1610. [DOI: 10.1111/anae.14845] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2019] [Indexed: 12/30/2022]
Affiliation(s)
- C. M. Kumar
- Department of Anaesthesiology Khoo Teck Puat Hospital SingaporeSingapore
| | - E. Seet
- Department of Anaesthesiology Khoo Teck Puat Hospital SingaporeSingapore
| | - T. Eke
- Department of Ophthalmology Norfolk and Norwich University Hospitals NorwichUK
| | - M. G. Irwin
- Department of Anaesthesiology The University of Hong Kong Hong Kong Special Administrative Region Hong Kong China
| | - G. P. Joshi
- Department of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas TX USA
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Mimouni M, Abualhasan H, Mtanes K, Mazzawi F, Barak Y. Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy. J Ophthalmol 2019; 2019:8098765. [PMID: 31467696 DOI: 10.1155/2019/8098765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/29/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection. Methods This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0–10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0–10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe. Results Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores (r = 0.43, p=0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (p=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (p=0.006). The ROC curve analysis revealed an area under the curve of 0.89 (p < 0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain. Conclusions Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).
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Adinehmehr L, Shetabi H, Moradi Farsani D, Salehi A, Noorbakhsh M. Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial. Anesth Pain Med 2019; 9:e87415. [PMID: 31341824 PMCID: PMC6616865 DOI: 10.5812/aapm.87415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/23/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure. Objectives The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field. Methods The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients' and surgeons' satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups. Results In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients' mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006). Conclusions The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients' satisfication scores, it is suggested that propofol was superior to the other two agents.
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Affiliation(s)
- Leili Adinehmehr
- Anesthesiology and Critical Care Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shetabi
- Anesthesiology and Critical Care Department, Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding Author: Anesthesiology Department, Al Zahra Medical Center, Isfahan University of Medical Sciences, Sofeh Blvd., Isfahan, Iran.
| | - Darioush Moradi Farsani
- Anesthesiology and Critical Care Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Salehi
- Ophthalmology Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Baenninger PB, Faes L, Kaufmann C, Reichmuth V, Bachmann LM, Thiel MA. Efficiency of video-presented information about excimer laser treatment on ametropic patients' knowledge and satisfaction with the informed consent process. J Cataract Refract Surg 2018; 44:1426-30. [PMID: 30274848 DOI: 10.1016/j.jcrs.2018.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate whether the presentation of a video within the informed consent consultation affects patient knowledge about refractive excimer laser treatment, satisfaction with the informed consent process, anxiety in respect to the planned surgery, and the consultation duration. SETTING Tertiary referral center, Lucerne, Switzerland. DESIGN Single-center, randomized controlled trial. METHODS Consenting eligible patients were randomly assigned to receive either a conventional face-to-face consultation (conventional group) or a conventional consultation with additional video-assisted information (interventional group). Knowledge and satisfaction with the informed consent process and anxiety regarding surgery were assessed. Differences between groups were tested with Wilcoxon-Mann-Whitney, Chi-square, and Student t tests. RESULTS The study comprised 113 patients (58 in the conventional group and 55 in the interventional group). There was no difference in terms of knowledge with 22/25 points (interquartile range [IQR], 3) in the conventional group versus 22/25 points (IQR, 2) in the interventional group (P = .957), satisfaction with the informed consent ("very satisfied": 47/58 versus 45/55; P = .915) and anxiety toward surgery with a median 8 (IQR, 4) versus median 9 (IQR, 3; P = .159). In the interventional group, however, the total consultation time was significantly lower than in the conventional group (-4.96 minutes; 95% CI, -9.50 to -0.43; P = .032). CONCLUSION Compared with a conventional consultation, video-assistance slightly reduced the total consultation time while maintaining patient knowledge, satisfaction with the informed consent process, and anxiety regarding the surgery on equal levels. Video-assistance could increase efficiency of clinical management on a double-digit percentage at an equal running cost compared with a conventional consultation.
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Lu Z, Li W, Chen H, Qian Y. Efficacy of a Dexmedetomidine-Remifentanil Combination Compared with a Midazolam-Remifentanil Combination for Conscious Sedation During Therapeutic Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Randomized, Single-Blinded Preliminary Trial. Dig Dis Sci 2018; 63:1633-1640. [PMID: 29594976 DOI: 10.1007/s10620-018-5034-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dexmedetomidine as a conscious sedative exhibits both analgesia and respiratory sparing effects. AIMS We evaluated and compared the sedative effect and the safety of a dexmedetomidine-remifentanil (DR) regimen with a midazolam-remifentanil (MR) combination during the endoscopic retrograde cholangio-pancreatography (ERCP) requiring conscious sedation. METHODS One-hundred and ninety-eight patients were randomized and divided into two groups. A bolus of midazolam (0.05 mg kg-1) was injected intravenously for MR group, and dexmedetomidine (1 μg kg-1) was pumping for 10 min for DR group. Next, an initial loading dose of 1 μg kg-1 and 0.05-0.2 μg kg-1 min-1 of remifentanil was administered in all patients. Hemodynamic and respiratory changes, Ramsay Sedation Scale, Visual Analogue Scale, endoscopist and patient satisfaction were assessed. Furthermore, adverse events as well as recovery time and discharge time were rated. RESULTS Patient satisfaction scores were significantly higher in the DR group compared with MR group. The occurrence of desaturation was statistically higher, and the operation time was longer in the MR group. Although no statistically significant values could be determined between the two groups about amnesia and need of additional drug, the DR group was found to require a significantly reduced amount of extra midazolam. Furthermore, nausea during catheterization of oropharynx was found to be more pronounced in the DR group. CONCLUSIONS The dexmedetomidine-remifentanil protocol provided a parallel sedative efficacy and improved respiratory sparing effects. The higher patient satisfaction scores potentially offer a more reproducible ERCP quality. Adding dexmedetomidine to remifentanil can be used safely as a conscious sedation method during ERCP.
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Affiliation(s)
- Zhiqiang Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, 210011, China
| | - Wenyuan Li
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, 210011, China
| | - Huiyu Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, 210011, China
| | - Yanning Qian
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Abstract
PURPOSE To evaluate the usefulness of intracameral lidocaine in cataract surgery under topical anesthesia and especially if the patient wanted intravenous sedation preoperatively. METHODS In this prospective study 96 patients were randomly assigned to receive 0.5 cc of balanced salt solution (Group 1) or 1% unpreserved lidocaine (Group 2). Patients who wanted sedation received intravenous midazolam hydrochloride. All surgery was done by one surgeon using a clear corneal technique. RESULTS Mean pain scores were 0.73 (of a maximum 3) in Group 1 and 0.54 in Group 2; the difference between groups was not statistically significant. Forty patients in Group 1 (83%) and 44 patients in Group 2 (92%) reported no discomfort or only mild discomfort. The two study groups were comparable in need for intravenous midazolam. Logistic regression analysis showed a significant relationship between pain scores and intravenous sedation (p=0.02) but not with intracameral lidocaine or other tested variables. However, odds ratio for pain increased to 5.1 (95% CI; 1.29-20.41) in participants without intravenous sedation compared to those with sedation. CONCLUSIONS The results of the present study suggest that intravenous sedation preoperatively seems to be an important determinant to relieve the sensation of discomfort/pain during small incision cataract surgery, but intracameral lidocaine was shown not to have a clinically useful role.
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Affiliation(s)
- J O Välimäki
- Department of Ophthalmology, Central Hospital of Lahti, Lahti, Finland and Department of Ophthalmology, University of Tampere, Tampere, Finland.
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Abstract
Purpose To determine the effects of intra-operative Korean traditional music on pain experienced by Korean patients undergoing sequential bilateral cataract surgery. Methods This was a two-sequence, two-period, and two-treatment crossover study. Fifty-two patients with cataracts were divided into two groups by block randomization, and bilateral cataract surgery was performed. In group 1, patients listened to Korean traditional music (KTM) during their first but not second cataract surgery. This sequence was reversed for patients in group 2. After each surgery, patients scored their pain intensity (PI) using a visual analog scale (VAS) ranging from 0 to 10, where 0 was ‘no pain’ and 10 was ‘unbearable pain.’ Result There was a statistically significant reduction in the mean VAS score with KTM (3.1 ± 2.0) compared to that without KTM (4.1 ± 2.2; p = 0.013). However, there were no statistically significant differences in blood pressure or pulse rates. Conclusion KTM had a significant effect on reducing pain experienced by patients during cataract surgery. This may be useful in the context of other surgical procedures to reduce pain in Korean patients.
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Affiliation(s)
- Suvin Choi
- Da Vinci College of General Education, Chung-Ang University, Seoul, Republic of Korea
| | - Sang-Gue Park
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Lorne Bellan
- Department of Ophthalmology, Misericordia Health Centre, Winnipeg, Canada
| | - Hyung-Hwan Lee
- School of Korean Music, Chung-Ang University, Anseong, Republic of Korea
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Tipotsch-maca SM, Varsits RM, Ginzel C, Vecsei-marlovits PV. Effect of a multimedia-assisted informed consent procedure on the information gain, satisfaction, and anxiety of cataract surgery patients. J Cataract Refract Surg 2016; 42:110-6. [DOI: 10.1016/j.jcrs.2015.08.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/04/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022]
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Chen M, Hill GM, Patrianakos TD, Ku ES, Chen ML. Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia. J Cataract Refract Surg 2015; 41:415-21. [DOI: 10.1016/j.jcrs.2014.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/15/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
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Aghadoost D, Fazel MR, Fakharian E. Comparing remifentanil versus propofol effect on pain and homodynamic change of patients undergoing phacoemulsification with topical anesthesia. Iran Red Crescent Med J 2013; 15:424-7. [PMID: 24349732 PMCID: PMC3838654 DOI: 10.5812/ircmj.2316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 04/08/2012] [Accepted: 04/21/2012] [Indexed: 12/21/2022]
Abstract
Introduction The purpose of this study was to compare remifentanil versus propofol effect on pain and homodynamic in patients undergoing phacoemulsification with topical anesthesia. Materials and Methods A double blind clinical trial was conducted to research following the approval of the ethical committee research of the university. One hundred volunteer subjects were randomly assigned into two equal groups (n = 50). The subjects in the propofol group received 3mg/kg/hr while the patients in the remifentanil drug received 3 µg/kg/hr of this medication. Phaco time, blood pressure and heart rate before and after surgery, respiratory depression (O2 sat < 90%) and vomiting, pain scores, ophthalmologist satisfaction and demographic data were recorded. Results The results of analysis showed that there were no significant differences between the age, sex, and duration of operation of the two treatment groups. Systolic, diastolic blood pressure and heart rate were significantly lower in the propofol group .The propofol group complained of pain than the remifentanil group (P = 0.001) while the surgeon satisfaction was higher for the remifentanil condition (P = 0.01). No significant differences were found between the two groups with respect to respiratory depression .No patient suffered from nausea and vomiting. Conclusions The results of this study indicated that using appropriate dose of remifentanil instead of propofol results in less pain, more stable homodynamic condition, and satisfaction of surgeon without no respiratory depression or perioperative nausea and vomiting.
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Affiliation(s)
- Dawood Aghadoost
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Fazel, Matini Hospital, Amirkabir Avenue. Kashan, IR Iran. Tel: +98-9132760380, Fax: +98-3615342025, E-mail:
| | - Esmaiel Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nail Duman E, Karaca M. Comparison of Five Percent Prilocaine-lidocaine Cream and Intravenous Fentanyl in Reducing the Spinal Puncture Pain. INT J PHARMACOL 2011. [DOI: 10.3923/ijp.2011.836.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kilic N, Sahin S, Aksu H, Yavascaoglu B, Gurbet A, Turker G, Kadioglu AG. Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. Eurasian J Med 2011; 43:13-7. [PMID: 25610153 PMCID: PMC4261372 DOI: 10.5152/eajm.2011.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. MATERIALS AND METHODS Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3-4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2-0.7 mcg/kg/hr, titrated to achieve an RSS of 3-4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9-10. Patient heart rates, arterial pressure and pain were evaluated. RESULTS Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p<0.05). There was no statistical difference in arterial pressure, RSS, MMSE or respiratory rate between the two groups. Coughing, nausea and vomiting occurred in 3 patients in Group M (12%), whereas no patient in Group D experienced these symptoms. The procedure elicited a gag response in 7 patients in Group M (28%) and in 4 patients in Group D (16%), with no significant difference between groups (p>0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). CONCLUSION The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam.
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Affiliation(s)
- Neslihan Kilic
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sukran Sahin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hale Aksu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Belgin Yavascaoglu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Alp Gurbet
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Gurkan Turker
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Asli Guler Kadioglu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
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Court H, Greenland K, Margrain TH. Measuring patient anxiety in primary care: Rasch analysis of the 6-item Spielberger State Anxiety Scale. Value Health 2010; 13:813-819. [PMID: 20561315 DOI: 10.1111/j.1524-4733.2010.00758.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The 6-item Spielberger State Anxiety Scale has been used as a replacement of the original version in many health-care studies. The purpose of this study was to evaluate the measurement properties of the shortened 6-item Spielberger State Anxiety Scale using Rasch analysis in general medical practice patients (N=297). METHODS Participants (aged 16 years or above) were recruited on a consecutive basis from three general medical practices. Prior to their appointment, participants were asked to complete a 6-item Spielberger State Anxiety Scale. RESULTS The results of the study showed that the scale is unidimentional, and each item measures a different level of patient anxiety. The rating scale operated well and item and person reliability was good. Furthermore, principal-components analysis of the residuals confirmed the scale measures a unitary concept. A scoring key was generated to allow conversion of raw scores to a continuous measurement. CONCLUSION The 6-item Spielberger State Anxiety Scale is shorter than the original version and has good psychometric properties. This would suggest the scale is a valid alternative to the full version for use in primary health-care practice and research.
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Affiliation(s)
- Helen Court
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
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Ho AL, Zakrzewski PA, Braga-Mele R. The effect of combined topical-intracameral anaesthesia on neuroleptic requirements during cataract surgery. Can J Ophthalmol 2010; 45:52-7. [PMID: 20130711 DOI: 10.3129/i09-204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate whether the addition of intracameral lidocaine to topical anaesthesia during cataract surgery leads to a decrease in the administration of intraoperative midazolam and fentanyl. DESIGN Retrospective case-control study. PARTICIPANTS The eyes of 124 patients undergoing phacoemulsification were included in the study, with 62 in the intracameral group and 62 in the control group. METHODS A single-centre, retrospective chart review of cases between April and October 2007 in which patients had undergone small-incision phacoemulsification with foldable intraocular lens insertion and received preoperatively either topical tetracaine 0.5% with unpreserved intracameral lidocaine 1% (intracameral group) or topical tetracaine 0.5% alone (control group). Intraoperatively, midazolam and fentanyl were administered as needed based on pain and anxiety. RESULTS A total of 124 eyes (124 patients) were included. There was no statistically significant difference between the mean intraoperative midazolam doses given for the 2 groups (p = 0.08). The mean intraoperative dose of fentanyl was lower in the intracameral than in the control group (p < 0.0001). A comparison of intraoperative fentanyl requirements between groups using a multivariate regression analysis for age, gender, surgical time, and preoperative fentanyl levels confirmed the lower need for intraoperative fentanyl in the intracameral compared with the control group (p = 0.0037). There were no anaesthetic complications among any of the study patients. CONCLUSIONS Patients receiving topical tetracaine 0.5% with unpreserved intracameral lidocaine 1% during cataract surgery demonstrated a reduction in intraoperative fentanyl requirements. Surgeons performing cataract surgery under topical anaesthesia should consider the addition of intracameral lidocaine 1% to decrease fentanyl requirements and improve patient safety and comfort.
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Affiliation(s)
- Adelyn L Ho
- University of British Columbia Medical School, Vancouver, BC, Canada
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Modi N, Shaw S, Allman K, Simcock P. Local anaesthetic cataract surgery: factors influencing perception of pain, anxiety and overall satisfaction. J Perioper Pract 2008; 18:28-33. [PMID: 18271335 DOI: 10.1177/175045890801800104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.
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Sharma NS, Ooi JL, Figueira EC, Rosenberg ML, Masselos K, Papalkar DP, Paramanathan N, Francis IC, Alexander SL, Ferch NI. Patient perceptions of second eye clear corneal cataract surgery using assisted topical anaesthesia. Eye (Lond) 2007; 22:547-50. [PMID: 17259915 DOI: 10.1038/sj.eye.6702711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To assess patient recall of intraoperative pain, anxiety, fear, and sensory (visual and auditory) perceptions during second eye clear corneal cataract surgery using assisted topical anaesthesia (ATA), in comparison with first eye cataract surgery using the same technique. METHODS This prospective, consecutive, observational study was conducted in a free-standing dedicated ophthalmic day surgery centre. A voluntary questionnaire was distributed to 129 consecutive patients who underwent clear corneal cataract surgery using ATA. Two patients had to be converted to block anaesthesia, and were excluded. Patients were asked to rate intraoperative pain, anxiety, and fear using a visual analogue scale (VAS), and recollection of intraoperative visual and auditory perceptions. Results were analysed using the Mann-Whitney U and Spearman correlation tests. RESULTS There were 70/127 (55%) patients undergoing first eye cataract surgery and 57/127 (45%) undergoing second eye surgery. There was no significant difference in mean pain, anxiety, and fear scores between those undergoing the second eye operation compared with those undergoing their first eye operation. Similarly, there was no significant difference in sensory perceptions between the two cohorts. Overall, there was a small but significant positive correlation between recall of visual and auditory perceptions and combined pain, fear, and anxiety scores (r=0.33, P=0.0002). CONCLUSION There was no significant difference in levels of intraoperative pain, anxiety, fear, and sensory perceptions experienced by patients between the first eye and second eye surgeries. We recommend that preoperative counselling for a patient's second eye be as comprehensive as for the first eye surgery.
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Affiliation(s)
- N S Sharma
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, Australia
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Ünal M, Yucel I, Altin M. Pain Induced by Phacoemulsification Performed by Residents Using Topical Anesthesia. Ophthalmic Surg Lasers Imaging Retina 2007; 38:386-91. [DOI: 10.3928/15428877-20070901-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gioia L, Cabrini L, Gemma M, Fiori R, Fasce F, Bolognesi G, Spinelli A, Beretta L. Sedative effect of acupuncture during cataract surgery: prospective randomized double-blind study. J Cataract Refract Surg 2006; 32:1951-4. [PMID: 17081902 DOI: 10.1016/j.jcrs.2006.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the effectiveness of acupuncture in reducing anxiety in patients having cataract surgery under topical anesthesia. SETTING Vita-Salute University of Milan and IRCCS H. San Raffaele, Milan, Italy. METHODS In a prospective randomized double-blind controlled trial, anxiety levels before and after cataract surgery in 3 groups (A = no acupuncture, B = true acupuncture starting 20 minutes before surgery, C = sham acupuncture starting 20 minutes before surgery) were compared using the Visual Analog Scale (VAS). Twenty-five patients scheduled for inpatient phacoemulsification were enrolled in each group. All surgeries were performed using topical anesthesia. Exclusion criteria were refusal to provide informed consent, use of drugs with sedative properties, psychiatric disease, pregnancy, knowledge of the principles of acupuncture, anatomic alterations, or cutaneous infections precluding acupuncture at the selected acupoints. RESULTS Preoperative anxiety levels were significantly lower only in Group B (P = .001). Anxiety in Group B was significantly lower than in Group A (P = .001) and Group C (P = .037). Regarding postoperative anxiety, the mean VAS score was 39 +/- 5 in Group A, 19 +/- 3 in Group B, and 31 +/- 4 in Group C. The difference was significant only between Group A and Group B (P = .003). CONCLUSION Acupuncture was effective in reducing anxiety related to cataract surgery under topical anesthesia.
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Affiliation(s)
- Luigi Gioia
- Departments of Anesthesiology, Vita-Salute University of Milan, and H. San Raffaele, Milan, Italy
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