[Role of deep sedation phacoemulsification with scleral tunnel]. / Intérêt de la sédation profonde dans la phacoémulsification par voie tunnelisée scléro-cornéenne.

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.