Venkatesh Rengaraj, Kenia Hemal, Sengupta Sabyasachi, Gopalakrishna Megha, Au Eong Kah-Guan
Aravind Eye Hospital, Pondicherry, India.
Future Vision Eye Care and Research Center, Mumbai, India.
Adv Ophthalmol Pract Res. 2021 Sep 9;1(1):100006. doi: 10.1016/j.aopr.2021.100006. eCollection 2021 Nov.
Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: a randomized controlled trial.
Prospective, double masked, randomized controlled trial.
150 eyes of 150 patients undergoing phacoemulsification and IOL implantation under topical anesthesia were randomized to receive either intravenous midazolam (0.015 mg/kg) or normal saline. The patients' experience was evaluated using a questionnaire. Vital signs including blood pressure and heart rate were measured before, during and after surgery. Mean arterial pressure (MAP) was calculated.
Both groups were comparable except that fewer patients in the control group were pseudophakic in the fellow eye (25.3% vs. 41.3%). More patients in the control group perceived hand movements (p < 0.01), surgeon/medical staff (p = 0.04) and sudden increase in vision during surgery (p < 0.01) compared to midazolam group. More control group patients experienced fear (p < 0.001), pain (p = 0.06) and unpleasant surgical experience (20.3% vs. 1.3%, p < 0.001). They also experienced greater fluctuation in MAP (16.9 ± 7.9 vs.7.2 ± 5.3, p < 0.001) and this was accentuated in hypertensives. After adjusting for age, gender, hypertension status and other eye lens status, multivariable logistic regression analysis revealed that subjects in the control arm (OR = 11.7, 95% [CI] = 1.3-108, p = 0.03), had a longer duration of surgery, experienced pain and more likely to report unpleasant experience. Adjusting for similar covariates, multivariable linear regression analysis showed that control group patients (β = 8.5 mmHg, 95% CI = 6.2-10.8, p = 0.03) had hypertension, experienced fear during surgery and greater fluctuations in the MAP.
A sedative dose of intravenous midazolam during phacoemulsification under topical anesthesia significantly reduces patients' visual experience, fear and fluctuations in MAP and improves overall surgical experience.
局部麻醉下白内障手术中静脉镇静对患者视觉体验和生命体征的影响：一项随机对照试验。
前瞻性、双盲、随机对照试验。
150例接受局部麻醉下超声乳化白内障吸除术及人工晶状体植入术的患者的150只眼被随机分为两组，分别接受静脉注射咪达唑仑（0.015mg/kg）或生理盐水。使用问卷评估患者的体验。在手术前、手术中和手术后测量包括血压和心率在内的生命体征。计算平均动脉压（MAP）。
两组具有可比性，除了对照组中患眼为人工晶状体眼的患者较少（25.3%对41.3%）。与咪达唑仑组相比，对照组更多患者感觉到手部动作（p<0.01）、外科医生/医护人员（p=0.04）以及手术中视力突然提高（p<0.01）。对照组更多患者经历恐惧（p<0.001）、疼痛（p=0.06）和不愉快的手术体验（20.3%对1.3%，p<0.001）。他们还经历了更大的MAP波动（16.9±7.9对7.2±5.3，p<0.001），且高血压患者这种波动更明显。在调整年龄、性别、高血压状态和其他晶状体状态后，多变量逻辑回归分析显示，对照组受试者（OR=11.7，95%[CI]=1.3-108，p=0.03）手术时间更长，经历疼痛且更有可能报告不愉快的体验。在调整相似协变量后，多变量线性回归分析显示，对照组患者（β=8.5mmHg，95%CI=6.2-10.8，p=0.03）患有高血压，在手术中经历恐惧且MAP波动更大。
局部麻醉下超声乳化白内障吸除术中给予镇静剂量的静脉咪达唑仑可显著减少患者的视觉体验、恐惧和MAP波动，并改善总体手术体验。
