Comparative Study of Hemodynamic Infusion of Dexmedetomidine with Alternative Sufentanil- midazolam Injection for Sedation of Patients Undergoing Cataract Surgery

In order to induce sedation during cataract surgery, various medications such as midazolam propofol and narcotics with different side effects are used in separation or in combination. Dexmedetomidine has no effect on the respiratory  system, but being dependent on dosage, it may cause cardiovasculardisorders . The present study aims to compare hemodynamic and sedative effects of dexmedetomidine and the combination of sufentanil-midazolam on patients undergoing cataract surgery. In a randomized clinical trial study, 60 patients were randomly divided into two dexmedetomidine and sufentanil-midazolam groups. In sufentanil – midazolam group,  dexmedetomidine  (DEX infusion at 0.5 μg/ kg for 10 minutes, then adjusted to 0.2 µg/kg/h) was prescribed.  In the sulfentanil-midazolam group,  sufentanil (0.1 μg /kg for 5  minutes )  and midazolam(0.2µg/kg) was injected five minutes before the operation.  Hemodynamic variables (Systolic blood pressure, diastolic blood pressure, heart rate), complications (nausea, vomiting, hypoxia), sedation level and pain intensity were recorded  (in the beginning of the study, 5, 10 minutes after anesthesia, at the start of surgery, 5, 10, 15 minutes after the surgery) as well as patient’s satisfaction, surgeon's satisfaction and complications.Results suggest that apart from gender, other primary characteristics of patients including age, history of blood pressure, diabetes history, ASA score, mean of systolic, diastolic blood pressure, heart rate and SPO2 levels were similar in both groups (P> 0.05). Systolic blood pressure   patients receiving dexmedetomidine  declined significantly more than that of patients receiving sufentanil-midazolam (P> 0.5). Diastolic blood pressure suddenly fell 5 minutes after the infusion of sufentanil-midazolam (P> 0.05), but then a relative increase and finally a relative decrease occurred  , while diastolic blood pressure in patients receiving dexmedetomidine decreased steadily . The mean heart rate in patients receiving dexmedetomidine and sufentanil-midazolam declined gently (P> 0.05). SPO2 reduced significantly in the sufentanil-midazolam group (P <0.05). drugs used  in both groups reduced pain intensity equally  (P> 0.05). From the beginning of the study, dexmedetomidine produced a relatively stable sedation level (score 2) based on Ramsay's criteria, while the combination of sufentanil-midazolam-medications cause deeper sedation (score 3) in patients (P <0.05). Despite this fact , 23.33% of the patient receiving sufentanil-midazolam could have movements during the surgerywhich was 6.66%  higher in patients receiving dexmedetomidine (P = 0.071). The satisfaction of patients receiving dexmedetomidine was significantly higher (P = 0.044), while the surgeon's satisfaction was almost identical in both anesthesia procedures (P = 0.94).In the end, the results of the present study showed that although dexmedetomidine is associated with few respiratory problems and higher satisfaction of patients, it decreases blood pressure and heart rate progressively. However, it seems that this medicine is more effective than a combination of midazolam-sufentanil  because of more patient satisfaction, lack of hypoxia, fewer complications, and more suitable immobility.