Dexmedetomidine sedation in painful posterior segment surgery

Ahmad Mansour,1,2 Samar Taha31Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Rafik Hariri University Hospital, Beirut, Lebanon; 3Department of Anesthesiology, American University of Beirut, Beirut, LebanonPurpose: To present a case series on the use of dexmedetomidine...

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Autores principales:	Mansour A, Taha S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/3f75399d78cf49d6905203b7749d2d0f
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spelling	oai:doaj.org-article:3f75399d78cf49d6905203b7749d2d0f2021-12-02T07:49:18ZDexmedetomidine sedation in painful posterior segment surgery1177-54671177-5483https://doaj.org/article/3f75399d78cf49d6905203b7749d2d0f2012-12-01T00:00:00Zhttp://www.dovepress.com/dexmedetomidine-sedation-in-painful-posterior-segment-surgery-a11738https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Ahmad Mansour,1,2 Samar Taha31Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Rafik Hariri University Hospital, Beirut, Lebanon; 3Department of Anesthesiology, American University of Beirut, Beirut, LebanonPurpose: To present a case series on the use of dexmedetomidine (Precedex) sedation in painful posterior segment surgery performed under topical anesthesia, similar to its use in cataract surgery.Methods: A prospective review of cases that had posterior segment surgery under topical anesthesia and that needed sedation. Dexmedetomidine-loading infusion was 1 mcg/kg over 10 minutes, followed by a maintenance infusion (0.5 mcg/kg/h).Results: Nine patients were operated on under topical anesthesia: two scleral buckle, five cryopexy, one scleral laceration, and one pars plana vitrectomy with very dense laser therapy in an albinotic fundus; six patients had retinal detachment. General or local anesthesia were not possible due to medical or ocular morbidities, use of anticoagulants, or the surgery plan changed intraoperatively when new pathologies were discovered. The surgeon achieved good surgical control in eight of nine cases, with one patient having ocular and bodily movements that were disturbing. Six patients had no pain, while three patients reported mild pain. No adverse effects were noted and all patients had successful surgical outcomes. Heart rate, blood pressure, and oxygen saturation were well controlled throughout the procedures. The most frequent adverse reactions of dexmedetomidine reported in the literature in less than 5% (hypotension, bradycardia, and dry mouth) were not recorded in the present study.Conclusion: When a surgeon has planned to do a pars plana vitrectomy under topical anesthesia and the surgical situation dictates the addition of cryopexy, scleral buckle, or intense laser retinopexy, then sedation with dexmedetomidine can help in the control of ocular pain in the majority of cases, with good intraoperative and immediate postoperative hemodynamic control with the possibility of supplemental rescue analgesia. Dexmedetomidine, a sedative analgesic, is devoid of respiratory depressant effects, and its use in posterior segment surgery under topical anesthesia is reported here for the first time.Keywords: dexmedetomidine, vitreoretinal surgery, topical anesthesiaMansour ATaha SDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2012, Iss default, Pp 2075-2079 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Mansour A Taha S Dexmedetomidine sedation in painful posterior segment surgery
description	Ahmad Mansour,1,2 Samar Taha31Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Rafik Hariri University Hospital, Beirut, Lebanon; 3Department of Anesthesiology, American University of Beirut, Beirut, LebanonPurpose: To present a case series on the use of dexmedetomidine (Precedex) sedation in painful posterior segment surgery performed under topical anesthesia, similar to its use in cataract surgery.Methods: A prospective review of cases that had posterior segment surgery under topical anesthesia and that needed sedation. Dexmedetomidine-loading infusion was 1 mcg/kg over 10 minutes, followed by a maintenance infusion (0.5 mcg/kg/h).Results: Nine patients were operated on under topical anesthesia: two scleral buckle, five cryopexy, one scleral laceration, and one pars plana vitrectomy with very dense laser therapy in an albinotic fundus; six patients had retinal detachment. General or local anesthesia were not possible due to medical or ocular morbidities, use of anticoagulants, or the surgery plan changed intraoperatively when new pathologies were discovered. The surgeon achieved good surgical control in eight of nine cases, with one patient having ocular and bodily movements that were disturbing. Six patients had no pain, while three patients reported mild pain. No adverse effects were noted and all patients had successful surgical outcomes. Heart rate, blood pressure, and oxygen saturation were well controlled throughout the procedures. The most frequent adverse reactions of dexmedetomidine reported in the literature in less than 5% (hypotension, bradycardia, and dry mouth) were not recorded in the present study.Conclusion: When a surgeon has planned to do a pars plana vitrectomy under topical anesthesia and the surgical situation dictates the addition of cryopexy, scleral buckle, or intense laser retinopexy, then sedation with dexmedetomidine can help in the control of ocular pain in the majority of cases, with good intraoperative and immediate postoperative hemodynamic control with the possibility of supplemental rescue analgesia. Dexmedetomidine, a sedative analgesic, is devoid of respiratory depressant effects, and its use in posterior segment surgery under topical anesthesia is reported here for the first time.Keywords: dexmedetomidine, vitreoretinal surgery, topical anesthesia
format	article
author	Mansour A Taha S
author_facet	Mansour A Taha S
author_sort	Mansour A
title	Dexmedetomidine sedation in painful posterior segment surgery
title_short	Dexmedetomidine sedation in painful posterior segment surgery
title_full	Dexmedetomidine sedation in painful posterior segment surgery
title_fullStr	Dexmedetomidine sedation in painful posterior segment surgery
title_full_unstemmed	Dexmedetomidine sedation in painful posterior segment surgery
title_sort	dexmedetomidine sedation in painful posterior segment surgery
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/3f75399d78cf49d6905203b7749d2d0f
work_keys_str_mv	AT mansoura dexmedetomidinesedationinpainfulposteriorsegmentsurgery AT tahas dexmedetomidinesedationinpainfulposteriorsegmentsurgery
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Dexmedetomidine sedation in painful posterior segment surgery

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