Comparison of midazolam-fentanyl versus propofol-ketamine sedation for peribulbar nerve block

Cataract surgery, a common operation in the elder, is frequently performed under regional anaesthesia.Retrobulbar nerve blocks (RBBs) are unpleasant and painful procedures. Sedation with benzodiazepines, and opiates are most commonly used alone or in combination. Inclusion creteria: ASA 1-3; patients older than 60 yr of age (max 80 yr) undergoing cataract extraction and intraocular lens implantation on an ambulatory surgery. Patients were excluded if: they weighed 150% of their ideal body weight; had ischemic heart disease; had uncontrolled hypertension (systolic/diastolic blood pressure 180/ 110 mm Hg) or had a history of allergy to ketamine, propofol, or local anesthetic drugs; had a history of psychiatric disorders; suffered memory or cognitive dysfunction; had ingested a opoids, tranquilizer or psychoactive drug within 2 wk of surgery. primary outcome are Patient satisfaction and Quality of sedation. patients divided to two groups: Intervention group (group pk): The assigned study drug was administered in the dose of 0.03 mL/kg (maximum 2.5 mL) as a bolus. Additional study drug was then administered in 0.5-mL increments 15 s apart until they were unresponsive to the verbal command “open your eyes.” Hypnotic dose and supplemental dose of the study drug were recorded. If the patient exhibited grimacing and/or extremity movement requiring restraint, further needle insertion was withheld. Supplemental study drug was then administered in 1 mL increments at 10- s intervals until little or no patient movement and/or grimacing occurred with the advancement of the needle.(max dose 5 ml ).Control group(group mf):The patients received either 1 microg/kg of fentanyl and 0.02 mg/kg of midazolam by bolus IV injection 1 minute before the administration of a PRBB. At the discretion of the anesthesiologist, intraoperative sedation consisting of 1-mL increments of the study drug or 0.5-mL increments of midazolam ( 1 mg/mL; maximal dose 2 mg) or fentanyl (50 mg/ mL; maximal dose 2 mL) could be administered to keep the patient comfortable but awake and responsive. This study was undertaken to compare quality of sedation for propofol-ketamine and midazolam-fentanyl sedation during peribulbar nerve block and to compare factors such as cardiopulmonary stability, and patient Satisfaction following sedation.

Theran University of Medical Sceinces