A Comparison of Sedative Effect of Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl during Cataract Surgery with Phacoemulsification Technique

Abstract

Background: Cataract surgery is one of the common surgeries worldwide. There are various medications for reducing anxiety and inducing sedation induction during this surgery. Midazolam is a benzodiazepine that is widely used for sedation in this surgery. Recently dexmedetomidine has its own adherents for sedation in cataract surgery, and is more preferred than midazolam in recent reports. This study aimed to compare the sedation effects of dexmedetomidine-fentanyl and midazolam-fentanyl in patients who were candidates for cataract surgery with phacoemulsification method. Methods: This double-blinded randomized clinical trial study was performed on 71 patients undergoing cataract surgery. Patients were divided into two groups receiving fentanyl-dexmedetomidine and fentanyl-midazolam. Demographic and hemodynamic data, arterial oxygen saturation, sedation quality, as well as patient’s and surgeon’s satisfaction were recorded at specific times and analyzed using SPSS software. Findings: There was no significant difference between the two groups based on age (P = 0.940), sex (P = 0.630), and body mass index (P = 0.390). Besides, there was no significant difference in terms of the mean score of sedation (P = 0.970) and the degree of patient’s (P = 0.600) and surgeon’s (P = 0.850) satisfaction. Repeated measures ANOVA showed significant differences between the groups in heart rate (P = 0.002) and oxygen saturation (P = 0.002) during the surgery. The prevalence of complications during surgery, including a decrease in oxygen saturation, hypotension, and bradycardia, was not significantly different between the two groups, too (P = 0.289). Recovery duration was significantly longer in dexmedetomidine-fentanyl group (P < 0.001). Conclusion: In cataract surgery, combination of dexmedetomidine-fentanyl produced sedation, as well as patient’s and surgeon’s satisfaction comparable to midazolam-fentanyl combination, with hemodynamic stability and no respiratory depression; however, it was accompanied by delayed recovery room discharge.

Keywords

• Dexmedetomidine
• Midazolam
• Cataract
• Phacoemulsification