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

Purpose: To determine the ideal sedative regimen for intraocular surgery un der peribulbar or retrobulbar block. The addition of alfentanil and or prop ofol to midazolam was evaluated with regard to hemodynamic variables, respi ratory rate, pain, anxiety, sedation, postoperative recovery and patient sa tisfaction. Methods: Eighty two patients aged between 50 and 85 were recruited into thi s prospective, randomised, double blind study. Patients, in four groups, re ceived 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 m g.kg(-1) midazolam and 5 mu g.kg(-1) alfentanil or 0.015 mg.kg(-1) midazola m alone. Blood pressure, heart rate, respiratory rate, pain, anxiety and se dation scores were measured, Times to discharge from the Post Anesthesia Ca re Unit (PACU) and Day Surgery Unit (DSU) were documented. A 24 hr telephon e interview was carried out to determine patient satisfaction. Results: Systolic blood pressure of patients in groups that had received al fentanil was 6% lower than that of patients who had not (P < 0.05) at the t ime of insertion of intraocular block. Patients in the alfentanil groups al so had lower respiratory rates during the first 15 min after drug administr ation, but all patients were given supplemental oxygen therefore oxygen sat uration was unaffected. Pain scores of patients who had been given alfentan il were lower during the first postoperative hour than those who had not. Conclusion: The addition of alfentanil to midazolam is advantageous in prov iding sedation for insertion of intraocular block.