Single-bolus dexmedetomidine in prevention of emergence delirium in pediatric ophthalmic surgeries: A randomized controlled trial.

Purpose: Emergency delirium (ED), a common postoperative neurologic complication, causes behavioral disturbances leading to self-traumas and also has long-term adverse effects in children. Our aim was to investigate the efficacy of a single-bolus dose of dexmedetomidine in reducing the incidence of ED. Additionally, pain relief, number of patients who needed rescue analgesia, hemodynamic parameters, and adverse events were assessed. Methods: One hundred and one patients were randomly allocated into two groups: 50 patients received 15 mL of dexmedetomidine 0.4 µg/kg (group D) and 51 patients received volume-matched normal saline (group C). Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored regularly throughout the procedure. ED was assessed with Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and pain was measured using the modified Objective Pain Score (MOPS). Results: The incidences of ED and pain were higher in group C than group D (P < 0.0001 and P < 0.0001, respectively). Group D showed significant decrease in MOPS and PAEDS values at 5, 10, 15, and 20 min (P < 0.05), HR at 5 min (P < 0.0243), and SBP at 15 min (P < 0.0127). There was no significant difference in DBP between the two groups at any time point. The mean blood pressure (MBP) at 10 min was significantly less in group D than group C (P < 0.001). Conclusion: Dexmedetomidine 0.4 µg/kg as a single bolus over 10 min immediately after intubation is effective for the prevention of ED and significantly reduces the need of rescue analgesia without compromising the hemodynamic parameters in children undergoing ophthalmic surgery.

Effect of sedation on visual sensations in patients undergoing cataract surgery under topical anaesthesia: a prospective randomized masked trial.

PURPOSE: The main aim of the study was to determine whether intravenous sedation with midazolam reduces the ability of patients to see during cataract surgery performed under topical anaesthesia. We also sought to determine the effects of sedation on patient's level of disturbance to the microscope light and visualization of surgical instruments and on the overall of experience of the patients during surgery. METHODS: A total of 78 patients, aged 40-75 years, were randomly divided into two groups: Group S, (sedation) who received intravenous midazolam 0.015 mg/kg, and Group NS, (no sedation) who did not receive midazolam. Patients with history of anxiety, those with history of intraocular surgery and those with severe chronic obstructive pulmonary disease were excluded. Topical anaesthesia was achieved by the application of 2% xylocaine gel over the conjunctiva. A blinded observer interviewed all the patients 30 min after the surgery using a standard questionnaire. RESULTS: Significant number of patients (25.6%) in Group NS was disturbed a lot because of the microscope light compared to Group S (5.1%), p = 0.021. Also, statistically significant number of patients in Group S (48.7%) compared to Group NS (20.5%) was not sure about the images perceived during surgery and were unable to recollect them after the surgery, p = 0.008, and 12.8% of the patients in Group NS reported the visual experience as frightening compared to 2.6% of patients in Group S, p = 0.239. CONCLUSION: Our study confirms that intravenous midazolam reduces both the ability to see and recall intraoperative visual images in patients undergoing cataract surgery under topical anaesthesia.