The Comparison of the Efficacy and Safety of Sedation With Etomidate- Fentanyl Versus Ketamine-Midazolam Combinations in Cataract Surgery



Aghadavoudi O¹ ; Balaei P² ; Akbari M³ Show Affiliations
Source: Journal of Isfahan Medical School Published:2012

Abstract

Background: Etomidate and ketamine are commonly used to induce sedation in cataract surgery due to their favorable hemodynamic side-effect profile. This study was performed to compare the efficacy and safety of etomidate/fentanyl with ketamine/midazolam combinations for inducing sedation in cataract surgery with phacoemulsification technique. Methods: This study was a double-blind active-control clinical trial. 94 patients scheduled for cataract surgery under sedation, were randomly assigned to receive either etomidate/fentanyl or ketamine/midazolam. Participants' blood pressure, heart rate, nausea and vomiting frequency, decreased arterial O2 saturation episodes, and recovery duration as well as the patients and surgeon satisfaction were recorded during the study period. Findings: No statistically significant differences were observed in systolic and diastolic blood pressure and heart rate between groups. Mean systolic blood pressure was 148.5 ± 25.1 in etomidate/fentanyl and 149.3 ± 22.0 in ketamin/midazolam groups (P = 0.87). Similarly, the patients of both groups reported the same levels of pain and nausea, but not vomiting episodes which have only happened in etomidate/fentanyl group. In contrast, patient satisfaction was significantly higher in ketamine/midazolam group (P = 0.001), although surgeon satisfaction were comparable with both combinations (P = 0.07). The members of both groups reached a desired level of sedation in 30 minutes and the between-group differences of sedation scores remained non-significant. However, myoclonus was only experienced by the etomidate/fentanyl group patients. Conclusion: Overall, this study demonstrated that the combination of etomidate/fentanyl is as efficient and safe as ketamine/midazolam in cataract surgery, without any significant side effects.