Comparison the Effects of Etomidate Infusion versus Ketamine-Midazolam-Fentanyl Combination in Sedation for Cataract Surgery

Document Type : Original Article (s)

Authors

1 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Etomidate has been used to induce anesthesia with minimum changes in hemodynamic profile in many surgeries. Nevertheless, its infusion for sedation during cataract surgery has been less evaluated. Methods: In a double-blind clinical trial study, 64 patients candidate for cataract surgery under sedation were randomly assigned to receive eitheretomidate-fentanyl (E/F) or ketamine-midazolam-fentanyl (K/M/F) combinations. Systolic and diastolic blood pressures, heart rate, oxygen saturation (SaO2), nausea and vomiting, movement frequency, sedation score, recovery duration, and patients' and surgeon's satisfaction were recorded during the surgeries.Findings: No statistically significant differences were observed in basic systolic and diastolic blood pressures and heart rate between the groups. But, mean systolic and diastolic blood pressures were significantly higher in K/M/F group during and after the surgery (P < 0.050). Systolic and diastolic blood pressures and heart rate did not have significant difference in E/F group (P > 0.050) during surgery but there was significant difference in K/M/F group (P < 0.050). SaO2 in recovery was significantly higher in E/F group (P < 0.001). Incidence of nausea, vomiting and movement episodes, sedation score, and patients' and surgeon's satisfaction were the same in both groups. Recovery duration was significantly less in E/F group (P < 0.001).Conclusion: Combination of etomidate and fentanyl for sedation could be as efficient and safe as ketamine, midazolam, and fentanyl combination in cataract surgery, with less hemodynamic profile changes and recovery time.

Keywords


  1. Waheeb S. Topical anesthesia in phacoemulsification. Oman J Ophthalmol 2010; 3(3): 136-9.
  2. Akgul A, Aydin ON, Dayanir V, Sen S, Ugur B, Kir E. Usage of remifentanil and fentanyl in intravenous patient-controlled sedo-analgesia. Agri 2007; 19(3): 39-46.
  3. Vinik RH. Co- induction: a practical application of anesthetic drug interaction. Curropin Anesthes 1993; 6(Suppl): S9-S13.
  4. Apan A, Doganci N, Ergan A, Buyukkocak U. Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery. Minerva Anestesiol 2009; 75(5): 239-44.
  5. Nordt SP, Clark RF. Midazolam: a review of therapeutic uses and toxicity. J Emerg Med 1997; 15(3): 357-65.
  6. Choi YF, Wong TW, Lau CC. Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation. Emerg Med J 2004; 21(6): 700-2.
  7. Miller RD, Cucchiara RF, Miller ED Jr, Reves JG, Roizen MF, Savarese JJ. Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone; 2010. p. 734-51.
  8. Lee-Jayaram JJ, Green A, Siembieda J, Gracely EJ, Mull CC, Quintana E, et al. Ketamine/midazolam versus etomidate/fentanyl: procedural sedation for pediatric orthopedic reductions. Pediatr Emerg Care 2010; 26(6): 408-12.
  9. Batjer HH. Cerebral protective effects of etomidate: experimental and clinical aspects. Cerebrovasc Brain Metab Rev 1993; 5(1): 17-32.
  10. Keim SM, Erstad BL, Sakles JC, Davis V. Etomidate for procedural sedation in the emergency department. Pharmacotherapy 2002; 22(5): 586-92.
  11. Jacoby J, Heller M, Nicholas J, Patel N, Cesta M, Smith G, et al. Etomidate versus midazolam for out-of-hospital intubation: a prospective, randomized trial. Ann Emerg Med 2006; 47(6): 525-30.
  12. Bordo D, Chan SB, Shin P. Patient satisfaction and return to daily activities using etomidate procedural sedation for orthopedic injuries. West J Emerg Med 2008; 9(2): 86-90.
  13. Forman SA. Clinical and molecular pharmacology of etomidate. Anesthesiology 2011; 114(3): 695-707.
  14. Lira RP, Nascimento MA, Arieta CE, Duarte LE, Hirata FE, Nadruz W. Incidence of preoperative high blood pressure in cataract surgery among hypertensive and normotensive patients. Indian J Ophthalmol 2010; 58(6): 493-5.
  15. Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, et al. Adverse intraoperative medical events and their association with anesthesia management strategies in cataract surgery. Ophthalmology 2001; 108(10): 1721-6.
  16. Kubitz JC, Motsch J. Eye surgery in the elderly. Best Pract Res Clin Anaesthesiol 2003; 17(2): 245-57.
  17. Vinson DR, Bradbury DR. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med 2002; 39(6): 592-8.
  18. Di LL, D'Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C. Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized controlled trial. Ann Emerg Med 2006; 48(4): 433-40, 440.
  19. Aghadavoudi O, Balaei P, Akbari M. The Comparison of the Efficacy and safety of sedation with etomidate-fentanyl versus ketamine-midazolam combinations in cataract surgery. J Isfahan Med Sch 2012; 30(209): 1631-8. [In Persian].
  20. Yates AM, Wolfson AB, Shum L, Kehrl T. A descriptive study of myoclonus associated with etomidate procedural sedation in the ED. Am J Emerg Med 2013; 31(5): 852-4.
  21. Hunt GS, Spencer MT, Hays DP. Etomidate and midazolam for procedural sedation: prospective, randomized trial. Am J Emerg Med 2005; 23(3): 299-303.
  22. Burton JH, Bock AJ, Strout TD, Marcolini EG. Etomidate and midazolam for reduction of anterior shoulder dislocation: a randomized, controlled trial. Ann Emerg Med 2002; 40(5): 496-504.