Propofol and dexmedetomidine for monitored anesthesia care during laser in situ keratomileusis.

BACKGROUND: The safety and efficacy of dexmedetomidine during laser in situ keratomileusis (LASIK) in stressed patients under topical anesthesia has not been fully investigated.

METHODS: We randomized 30 adult patients with ametropia, with a Self-Rating Anxiety Scale score greater than 50, who were undergoing LASIK to receive dexmedetomidine (DEX group), propofol (P group), or placebo. No differences in baseline characteristics were observed between the groups. In the DEX group, dexmedetomidine was loaded (0.3 μg/kg) before superficial anesthesia for eye surgery. Mean arterial pressure, heart rate (HR), oxygen saturation (SpO2), bispectral index (BIS) monitoring, and end-tidal CO2 were recorded before infusion (baseline) and every 5 minutes after loading of the study drugs. The degree of sedation was evaluated using the Ramsay Sedation Scale by an anesthesiologist who was unaware of the type of sedative used. The satisfaction of the patients and surgeon was assessed immediately after surgery using a 7-point Likert-like verbal rating scale.

RESULTS: Significantly lower HR was observed over time in the DEX group compared with the P group. No significant differences in SpO2 were observed between the groups. Bispectral index scores decreased at 10, 15, and 20 minutes after infusion. The surgeon's satisfaction scores were higher in the DEX group than in the P group. Recovery times were longer in DEX group than in the P group.

CONCLUSIONS: Dexmedetomidine in conjunction with topical anesthesia offered better conscious sedation for nervous patients during LASIK, but these patients required a longer recovery period.