UC Davis Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
BMC Anesthesiol. 2020 Apr 4;20(1):75. doi: 10.1186/s12871-020-00973-4.
Cataract surgery is one of the most common procedures performed worldwide in the elderly. Various medications can provide effective anesthesia and analgesia for cataract surgery, but undesirable side effects limit the utility of each medication or combination of medications. Dexmedetomidine may serve as an anesthesia adjunct for outpatient cataract surgery in the elderly.
Searches were conducted in Cochrane, Embase, and PubMed for randomized clinical trials investigating the use of dexmedetomidine in adult patients undergoing outpatient, or ambulatory, cataract surgery with sedation and topical or peribulbar block. Ninety-nine publications were identified, of which 15 trials satisfied the inclusion criteria. A total of 914 patients were included in this review. The following data were collected: American Society of Anesthesiologists' (ASA) physical status and age of study patients; method of blinding and randomization; medication doses and routes of administration; and intraoperative levels of sedation. We also recorded statistically significant differences between dexmedetomidine and other study medications or placebo with respect to the following outcomes: hemodynamic and respiratory parameters; pain; sedation; post-operative nausea and vomiting (PONV); discharge from post-anesthesia care unit (PACU) or recovery times; patient satisfaction; surgeon satisfaction; and effects on intraocular pressure (IOP).
Hypotension with or without bradycardia was reported following bolus doses of dexmedetomidine ranging from 0.5-1.0 mcg/kg with or without a continuous dexmedetomidine infusion. Delayed PACU discharge times were associated with the use of dexmedetomidine, but no clear association was identified between delayed recovery and higher levels of intraoperative sedation. Better analgesia and higher patient satisfaction were commonly reported with dexmedetomidine as well as reductions in IOP.
Overall, this review demonstrates better analgesia, higher patient satisfaction, and reduced IOP with dexmedetomidine for outpatient cataract surgery when compared to traditional sedatives, hypnotics, and opioids. These benefits of dexmedetomidine, however, must be weighed against relative cardiovascular depression and delayed PACU discharge or recovery times. Therefore, the utility of dexmedetomidine for outpatient cataract surgery should be considered on a patient-by-patient basis.
白内障手术是全球老年人最常见的手术之一。各种药物可为白内障手术提供有效的麻醉和镇痛，但每种药物或药物组合的不良副作用限制了其用途。右美托咪定可用作老年人门诊白内障手术的麻醉辅助剂。
在 Cochrane、Embase 和 PubMed 中搜索了关于右美托咪定在接受门诊或日间白内障手术镇静和局部或球周阻滞的成年患者中使用的随机临床试验。确定了 99 篇出版物，其中 15 项试验符合纳入标准。本综述共纳入 914 例患者。收集了以下数据：美国麻醉医师协会（ASA）身体状况和研究患者年龄；盲法和随机分组方法；药物剂量和给药途径；以及术中镇静水平。我们还记录了右美托咪定与其他研究药物或安慰剂在以下结果方面的统计学显著差异：血流动力学和呼吸参数；疼痛；镇静；术后恶心和呕吐（PONV）；离开麻醉后护理单位（PACU）或恢复时间；患者满意度；外科医生满意度；以及对眼压（IOP）的影响。
报道了在使用 0.5-1.0 mcg/kg 右美托咪定负荷剂量或使用右美托咪定持续输注时，出现低血压伴或不伴心动过缓。使用右美托咪定与 PACU 延迟出院时间有关，但与术中镇静水平较高无明确关联。与传统镇静剂、催眠剂和阿片类药物相比，右美托咪定通常可提供更好的镇痛效果、更高的患者满意度以及降低眼压。
总体而言，与传统镇静剂、催眠剂和阿片类药物相比，右美托咪定可提供更好的门诊白内障手术镇痛效果、更高的患者满意度和降低眼压。然而，必须权衡右美托咪定相对的心血管抑制作用以及 PACU 延迟出院或恢复时间。因此，应根据患者的具体情况考虑右美托咪定在门诊白内障手术中的应用。
