NİMET ŞENOĞLU, Meral EZBERCİ, Beyazıt ZENCİRCİ, Hafize ÖKSÜZ, GÖKHAN ÖZDEMİR

Katarakt cerrahisinde premedikasyonda uygulanan midazolam ve deksmedetomidinin göziçi basıncı üzerine erken dönemde etkileri

Giriş ve Amaç: Retrobulber blok ile katarakt ameliyatı uygulanan hastalarda, premedikasyonda sedasyon amaçlı kullanılan deksmedetomidinin, uygunluğunu ve göziçi basıncına (GİB) etkisini midazolam ile karşılaştırmayı planladık. Yöntem: Katarakt cerrahisi uygulanacak 30 hasta randomize olarak deksmedetomidin (Group D) ve midazolam (Group M) gruplarına ayrıldı. Grup D`de 10 dakika sürede infüzyonla 1 mcg kg-1 deksmedetomidin verilirken, Grup M`de 20 mcg kg-1 tek doz midazolam intravenöz olarak uygulandı. Ek olarak, her iki gruba 0.5 mg kg–1 tramadol intravenöz olarak 3 dakikada uygulandı. Göz içi basıncı; topikal anestezi sonrası 3. dakikada bazal ölçüm (1. ölçüm), 15. dakika (2. ölçüm), ve 30. dakika (3. ölçüm) ile retrobulber blok sonrası 10. dakikada (4. ölçüm) yapıldı. Bulgular: Bazal değere göre GİB değişiklikleri deksmedetomidin grubunda midazolam ile karşılaştırıldığında belirgin derecede azalmıştı (p

Anahtar Kelimeler:

Premedikasyon, Katarakt, Göz içi basınç, Midazolam, Deksmedetodimin

The early effect of premedication with midazolam and dexmedetomidine on intraocular pressure during cataract surgery

Objective: We assessed the effect of dexmedetomidine on intraocular pressure (IOP) and the suitability for sedation during cataract surgery under retrobulbar block anesthesia and compared those with midazolam. Method: Thirty patients having elective cataract surgery were randomized to receive dexmedetomidine (Group D) or midazolam (Group M). Group D received a loading dose of 1 mcg kg-1 dexmedetomidine over 10 minutes, Group M received single dose of 20 mcg kg-1 of midazolam. In addition intravenous tramadol was given over 3 minutes. Measurements of IOP were taken at baseline (1st measurement), 15th, 30th minutes after premedication (2nd and 3rd measurements), and 10th minutes after retrobulbar block (4th measurement). Results: The percent change in IOP from baseline was significantly less in the dexmedetomidine group compared with the midazolam group (p<0.05). Midazolam reduced intraocular pressure, however, dexmedetomidine produced significant and sufficient sedation, significant anxiolysis compared with midazolam (p<0.05). Systolic, diastolic and mean blood pressures decreased moderately (<20 %), but it was significant in dexmedetomidine group. Oxygen saturation values at all times remained well and there were no significant side effects in either group. All patients recovered from sedation rapidly. Conclusion: Premedication with dexmedetomidine may be useful and an altenative for elderly patients before cataract surgery under retrobulbar block.

Keywords:

Premedication, Cataract, Intraocular Pressure, Midazolam, Dexmedetomidine,

Tam Metin

Kaynakça

1. Morgan GE, Mikhail MS, Murray MJ. Anesthesia for Ophtalmic Surgery. In: Clinical Anesthesiology. Morgan GE, Mikhail MS, Murray MJ (eds). 3 rd edition. New York: Mc Graw-Hill, 2002: 761-70.

2. Karabıyık L, Çetin H, Çukur S. Yaşlılardarda "bilinçli sedasyon" için uygulanan midazolam intraoküler basınç azaltır mı? Çukurova Üniversitesi Tıp Fakültesi Dergisi 1998; 23:160-5.

3. Virkkila ME, Ali-Melkkila TM, Kanto JH. Premedication for outpatient cataract surgery: a comparative study of intramuscular alfentanil, midazolam and placebo. Acta Anaesthesiol Scand 1992; 36: 559-63.

4. Virkkila M, Ali-Melkkila T, Kanto J, Turunen J, Scheinin H. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia 1994; 49(10): 853-8.

5. Kiefer RT, Weindler J, Ruprecht KW. Oral low-dose midazolam as premedication for intraocular surgery in retrobulbar anesthesia: cardiovascular effects and relief of perioperative anxiety Eur J Ophthalmol 1997;7:185-92.

6. Carter K, Faberowski LK, Sherwood MB, Berman LS, McGorray S. A randomized trial of the effect of midazolam on intraocular pressure. J Glaucoma 1999; 8: 204-7.

7. Rewari V, Madan R, Kaul HL, Kumar L, Remifentanil and propofol sedation for retrobulbar nerve block. Anaesth Intensive Care. 2002; 30: 433-7.

8. Morgan GE, Mikhail MS, Murray MJ. Geriatric Anesthesia. In: Clinical Anesthesiology. Morgan GE, Mikhail MS, Murray MJ (eds). 3 rd edition. New York: Mc Graw-Hill, 2002: 875-880.

9. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95: 461-6.

10. Esener Z. Yaşlı Hastalarda Anestezi. Esener Z (eds). In: Klinik Anestezi. 2. baskı. Logos yayıncılık;1997: 592-5.

11. Kiefer RT, Weindler J, Ruprecht KW. Oral low-dose midazolam as premedication for intraocular surgery in retrobulbar anesthesia: cardiovascular effects and relief of perioperative anxiety. Eur J Ophthalmol 1997;7:185-92.

12. Jaakola ML. Dexmedetomidine premedication before intravenous regional anesthesia in minor outpatient hand surgery. J Clin Anesth 1994; 6: 204-11.

13. Jaakola ML, Ali-Melkkila T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth 1992; 68(6): 570-5.

14. Muttu S, Liu EH, Ang SB, Chew BT, Lee TL, Ti LK.Comparison of dexmedetomidine and midazolam sedation for cataract surgery under topical anesthesia. J Cataract Refract Surg 2005;31: 1845-6.