Efficacy Of Midazolam Only Versus Fentanyl And Midazolam In Monitored Anesthesia Care During Routine Cataract Surgery With Phacoemulsification

To assess different approaches to monitored anesthesia care (MAC) during routine cataract surgery with phacoemulsification by comparing the drug(s) used, and determine the approach that gave optimal patient comfort and cooperation during surgery.

The majority of data was collected at the outpatient surgery department at Fresno Surgical Hospital. Post-operative data was collected at Insight Vision Center, an independent ophthalmology practice. 

The anesthesia used and the timing of agents was recorded during the intra-operative process. Immediately following surgery, the single surgeon rated their impression from 1-5 on three factors: surgeon’s perceived patient cooperation, patient’s verbally expressed comfort, and patient’s non-verbally expressed comfort. Additionally, patient impressions were recorded at post-op day 1 on a scale of 1-5 on their perceived comfort during the surgery and during the rest of the operative day. The first 101 consecutive cases that met the inclusion criteria were recorded. All information was recorded by the surgeon’s scribe, who was present both at the surgery center and in the clinic for post-op day 1.

Of 101 patients total, 49 patients were administered midazolam only, and 50 patients were administered fentanyl citrate and midazolam. Using midolazam+fentanyl in combination returned significantly better surgeon’s perceived cooperation (p=0.0246) and patient’s verbal comfort (p=0.0359) compared to midazolam alone. No significant difference was seen in patients' nonverbal comfort during surgery (p=0.0691). No significant differences were observed when comparing the first eye vs the second eye in each individual drug category. Patients’ post-op perceptions of comfort did not show any significant differences between medication categories.