Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

Abstract

Objective: The aim of this study is to compare the sedative properties and haemodynamic and respiratory effects of dexmedetomidine and a ketamine-propofol combination (ketofol), which are expected to have minimal effects on spontaneous breathing. Methods:Sixty patients were enrolled in this prospective randomised study. Patients were divided into 2 groups according to the administration of dexmedetomidine (Group D) and ketofol (Group K). Target sedation level was determined as a Ramsay Sedation Score of 3. In Group D, 0.5 mcg kg -1 dexmedetomidine was administered via intravenous route in 10 minutes versus 0.125 mL kg -1 of a solution containing 200 mg propofol and 100 mg ketamine in Group K. Haemodynamic and respiratory effects, postoperative awakening time, analgesic properties and satisfaction levels of the patients and surgeon were assessed.Results: There was a statistically significant decrease in mean arterial pressures following drug administration compared to initial measurements in both groups. However, there was a statistically significant decrease in heart rate only in Group D. There was no significant difference between the two groups regarding respiratory rate and protection of spontaneous respiration. Although the time for Aldrete score to be 9 was 16.1 minutes for Group K, it was 24.9 minutes for Group D, and this difference was statistically significant (p<0.01). There was no significant difference between the two groups regarding adverse effects, pain scores and satisfaction levels of the patients and surgeon.Conclusion: Compared to dexmedetomidine, at similar sedation levels, sedation provided by ketofol enables satisfactory analgesia. Moreover, ketofol has a more rapid onset of action and a shorter recovery period from anaesthesia without causing significant haemodynamic or respiratory adverse effects. Bulgular:Her iki grupta da ortalama arter basınçları ilaç uygulamaları sonrası başlangıç ölçümlerine oranla anlamlı bir azalma gösterdi. Kalp atım hızı ise sadece Grup D'de anlamlı olarak azaldı. Solunum sayısı ve spontan solunumun korunması açısından iki grup arasında fark yoktu. Aldrete puanının 9 olma zamanı Grup K'da 16,1 dk iken Grup D'de 24,9 dk idi ve aralarındaki fark istatistiksel açıdan anlamlıydı (p<0,01). Yan etkiler, ağrı skorları, hasta ve cerrah memnuniyeti açısından gruplar arasında anlamlı farklılık yoktu.Sonuç: Çalışmamız sonucunda ketofol ile oluşturulan sedasyonun deksmedetomidinle karşılaştırıldığında, benzer sedasyon seviyesinde yeterli analjezi sağladığını ve hemodinamik ve solunumsal açıdan önemli bir yan etkiye yol açmaksızın daha kısa etki başlan-gıcı ve daha kısa derlenme süresine sahip olduğunu tespit ettik. 84 Giriş K atarakt cerrahisi ve vitreoretinal cerrahi en sık uygulanan oftalmik cerrahi prosedürlerdir ve genellikle sedasyon eşli-ğinde veya sedasyon olmadan lokal anestezi (LA) altında gerçekleştirilir (1, 2). Sedasyon amacıyla sıklıkla propofol, benzodiyazepinler, opioidler ve bunların kombinasyonları kullanılmaktadır. Katarakt cerrahisi çoğunlukla ileri yaş-t...

Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review

“…Seven studies in our review demonstrated significant reductions in IOP [13,15,[18][19][20][21]23]. One study reported a 3.8 mmHg decrease in IOP compared to control after a 1 mcg/kg bolus of dexmedetomidine [21].…”

“…One study noted that dexmedetomidine-treated patients required more time to achieve an Aldrete score of 10 when compared to midazolam-treated patients [median interquartile range (IQR): 45 (36-54) vs 21 (10-32) min, P < 0.01] [12]. Prolonged PACU discharge times were also noted in a study comparing dexmedetomidine to ketofol [mean time to achieve Aldrete score 9 (standard deviation (SD)): 24.9 (4.5) vs 16.1 (2.1) min, P < 0.001] [18]. These findings were not consistent with one study that utilized intravenous dexmedetomidine 1 mcg/kg followed by patient-controlled sedation with dexmedetomidine, which demonstrated no statistically significant differences in Aldrete scores at 30 min postoperatively compared to patients who received no sedation [21].…”

“…Two studies titrated dexmedetomidine, remifentanil, and midazolam to pre-determined target levels of sedation as defined by Bispectral index (BIS) scores 70-80 and > 85 [10,11]. Of the remaining studies, 7 titrated medications to Ramsay Sedation Scale (RSS) scores of 2 or 3 [12][13][14][15][16][17][18]. Two studies administered intramuscular (IM) dexmedetomidine 45 min prior to the regional block [19,20].…”

“…− 1 without initial boluses; arterial pressures that defined hypotension in these studies, however, were not specifically provided [17,24]. Omitting a continuous infusion of dexmedetomidine was not associated with preserved arterial pressure or heart rate in any of the studies included in this review [15,[18][19][20]. Table 3 displays the effects of dexmedetomidine on arterial pressure and heart rate compared to other study medications and placebo.…”

“…Four studies investigated the time necessary to achieve a pre-determined target Aldrete score [12,13,15,18]. One study noted that dexmedetomidine-treated patients required more time to achieve an Aldrete score of 10 when compared to midazolam-treated patients [median interquartile range (IQR): 45 (36-54) vs 21 (10-32) min, P < 0.01] [12].…”