A comparison of midazolam, alfentanil and propofol for sedation in outpatient intraocular surgery

Purpose: To determine the ideal sedative regimen for intraocular surgery under peribulbar or retrobulbar block. The addition of alfentanil and or propofol to midazolam was evaluated with regard to hemodynamic variables, respiratory rate, pain, anxiety, sedation, postoperative recovery and patient satisfaction. Methods: Eighty two patients aged between 50 and 85 were recruited into this prospective, randomised, double blind study. Patients, in four groups, received 0.015 mg.kg(-1) midazolam, 5 mu g.kg(-1) alfentanil and 0.15 mg.kg(-1) propofol; 0.015 mg.kg(-1) midazolam and 0.15 mg.kg(-1) propofol; 0.015 mg.kg(-1) midazolam and 5 mu g.kg(-1) alfentanil or 0.015 mg.kg(-1) midazolam alone. Blood pressure, heart rate, respiratory rate, pain, anxiety and sedation scores were measured, Times to discharge from the Post Anesthesia Care Unit (PACU) and Day Surgery Unit (DSU) were documented. A 24 hr telephone interview was carried out to determine patient satisfaction. Results: Systolic blood pressure of patients in groups that had received alfentanil was 6% lower than that of patients who had not (P < 0.05) at the time of insertion of intraocular block. Patients in the alfentanil groups also had lower respiratory rates during the first 15 min after drug administration, but all patients were given supplemental oxygen therefore oxygen saturation was unaffected. Pain scores of patients who had been given alfentanil were lower during the first postoperative hour than those who had not. Conclusion: The addition of alfentanil to midazolam is advantageous in providing sedation for insertion of intraocular block.