European Journal of Cardiovascular Medicine

Ophthalmic day-care procedures, including cataract surgery, chalazion excision, pterygium excision require adequate sedation to ensure patient immobility, comfort, and cooperation while maintaining airway reflexes. Midazolam, a benzodiazepine, is widely used for its anxiolytic and amnesic properties, but may be associated with respiratory depression and delayed recovery.

Dexmedetomidine, a selective α2-adrenergic agonist, offers sedation with analgesia and sympatholytic effects, mimicking natural sleep and causing minimal respiratory compromise. It may provide smoother intraoperative behavior and improved patient and surgeon satisfaction. Evidence comparing dexmedetomidine and midazolam in ophthalmic day-care surgeries remains limited.

This study aimed to compare sedation quality, hemodynamic stability, recovery, and patient and surgeon satisfaction between dexmedetomidine and midazolam in adult patients undergoing ophthalmic day-care procedures, primarily cataract surgery, under local anesthesia.

Study Design: Prospective, randomized, double-blind controlled study at Dr Somervell Memorial CSI Medical College and Hospital, Thiruvananthapuram from June 2024 to May 2025.

Sample Size: 100 adult patients (50 per group), powered to detect a 15% difference in satisfaction with α=0.05, power 80%.

Inclusion Criteria:
- Age 18–70 years
- ASA I–II
- Elective ophthalmic day-care surgery under local anesthesia (primarily cataract procedures)

Exclusion Criteria:
- Cardiac conduction abnormalities
- Chronic sedative use
- Hepatic or renal impairment
- Allergy to study drugs

Randomization and Blinding: Computer-generated sequence; anesthesiologist and outcome assessors blinded.

Anesthesia Protocol:
- Group D (Dexmedetomidine): Loading 1 µg/kg IV over 10 min, then 0.2–0.5 µg/kg/h infusion
- Group M (Midazolam): 0.03 mg/kg IV bolus, then 0.01–0.02 mg/kg/h infusion
- Local anesthesia administered after achieving adequate sedation (RSS ≥3)

Monitoring: Standard ASA monitoring (HR, BP, SpO₂, ECG)

Outcome Measures:
- Primary: Ramsay Sedation Scale, patient satisfaction (5-point Likert)
- Secondary: Hemodynamics, surgeon satisfaction (5-point scale), recovery time (Aldrete ≥9), adverse events

Statistical Analysis: Data analyzed with SPSS v25. Continuous variables: Student’s t-test; categorical variables: Chi-square. p<0.05 considered significant.

Demographics: Groups comparable in age, gender, ASA status (p>0.05).

Sedation Scores: Dexmedetomidine 3.8 ± 0.4, Midazolam 2.9 ± 0.5 (p<0.001)

Hemodynamic Parameters: HR: 72 ± 8 vs 78 ± 9, MAP: 92 ± 6 vs 96 ± 8

Recovery Times: 23 ± 6 min vs 21 ± 5 min (p=0.21)

Patient and Surgeon Satisfaction: Patient satisfaction: 4.7 ± 0.3 vs 3.9 ± 0.4, Surgeon satisfaction: 4.5 ± 0.5 vs 4.1 ± 0.6

Adverse Events: Mild dry mouth in 3 patients of dexmedetomidine group; no respiratory depression or other serious events.

Dexmedetomidine provided superior sedation, stable hemodynamics, and higher patient and surgeon satisfaction compared to midazolam. Its cooperative sedation allows patients to remain calm yet responsive, ideal for ophthalmic procedures requiring patient cooperation.

The study demonstrates dexmedetomidine’s effectiveness in adult ophthalmic day-care surgeries, particularly cataract procedures. Midazolam remains an effective alternative, though with variable sedation and potential respiratory compromise.

Dexmedetomidine is a superior sedative agent for ophthalmic day-care procedures under local anesthesia, providing better patient comfort, hemodynamic stability, and satisfaction, without prolonging recovery.

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