|
1
|
Irawati D, Adli M, Yadi DF. Successful Use of Low-Dose Combination Propofol and Fentanyl in Cataract Surgery Phacoemulsification. Clin Ophthalmol 2023; 17:1929-1937. [PMID: 37431431 PMCID: PMC10329823 DOI: 10.2147/opth.s415852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
Background The combination between sedatives and opioids is one of the recommended anesthetic options in ophthalmic procedures and regimens are more advantageous as smaller amounts of each drug can be administered to reduce side effects and have proper outcomes due to the synergistic effects. This study aims to observe the use of low-dose propofol and fentanyl for patients undergoing phacoemulsification surgery. Material and Methods This observational study involves a sample of 125 adult patients who underwent elective cataract procedures using the phacoemulsification technique and had an American Society of Anesthesiologists (ASA) physical status of 1 to 3. Dose amount of fentanyl and propofol, Ramsay score, hemodynamic parameter, side effects, and patient satisfaction were evaluated, recorded, and analyzed using a 5-point Likert scale. Results The result showed the mean absolute dose of propofol was 12.46±4.376 mg, with a range between 10 and 30 mg, while the mean per body weight was 0.21±0.075 mg. Similarly, the mean absolute dose for fentanyl was 25.04±3.012 mcg within the range of 10-50 mcg, and the per-body weight dose was 0.43±0.080 mcg. About 90.4% and 9.6% of the patients reached Ramsay 2 and 3, respectively. The analysis of systolic, diastolic blood pressure, mean arterial pressure, and pulse rate showed that the combination of low-dose fentanyl and propofol was significantly lower than before therapy administration in all four values (p < 0.05). Conclusion The combination of low-dose propofol and fentanyl in cataract surgery using phacoemulsification successfully reached the targeted sedation level and a significant decrease in blood pressure, MAP, pulse rate, minimal side effects, and high satisfaction rate.
Collapse
Affiliation(s)
- Dian Irawati
- Department of Anesthesiology, National Eye Center Cicendo Eye Hospital-Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Muhamad Adli
- Department of Anesthesiology, National Eye Center Cicendo Eye Hospital-Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Dedi Fitri Yadi
- Department of Anesthesiology, Dr. Hasan Sadikin General Hospital- Universitas Padjadjaran, Bandung, West Java, Indonesia
| |
Collapse
|
|
2
|
Davidson RS, Donaldson K, Jeffries M, Khandelwal S, Raizman M, Rodriguez Torres Y, Kim T. Persistent opioid use in cataract surgery pain management and the role of nonopioid alternatives. J Cataract Refract Surg 2022; 48:730-740. [PMID: 34753878 PMCID: PMC9119400 DOI: 10.1097/j.jcrs.0000000000000860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
Cataracts are a leading cause of preventable blindness globally. Although care varies between developing and industrialized countries, surgery is the single effective approach to treating cataracts. From the earliest documented primitive cataract removals to today's advanced techniques, cataract surgery has evolved dramatically. As surgical techniques have developed, so have approaches to surgical pain management. With current cataract surgical procedures and advanced technology, anesthesia and intraoperative pain management have shifted to topical/intracameral anesthetics, with or without low-dose systemic analgesia and anxiolysis. Despite this, pain and discomfort persist in some patients and are underappreciated in modern cataract surgery. Although pain management has progressed, opioids remain a mainstay intraoperatively and, to a lesser extent, postoperatively. This article discusses the evolution of pain management in cataract surgery, particularly the use of opioids and the associated risks as well as how ophthalmology can have a positive impact on the opioid crisis.
Collapse
Affiliation(s)
- Richard S. Davidson
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Kendall Donaldson
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Maggie Jeffries
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Sumitra Khandelwal
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Michael Raizman
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Yasaira Rodriguez Torres
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Terry Kim
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| |
Collapse
|