Intravenous sedation for ocular surgery under local anaesthesia

Anterior segment ophthalmic surgery is commonly performed under local anaesthesia. In order to improve patient comfort, a variety of sedation techniques has been employed in the past. The object of this study was, firstly, to determine whether continuous intravenous sedation during surgery offered any advantages in patients premedicated with temazepam and metoclopramide, and, secondly, to compare midazolam to propofol for this purpose. Forty nine patients were randomly aliocated to receive no intravenous sedation (n=15), continuous propofol infusion (n=17), or continuous intravenous midazolam infusion (n=17) after peribulbar anaesthesia. Each technique provided cardiovascular and respiratory stability and aliowed early recovery with minimal postoperative sequelae. Unexpected ocular field movement occurred more commonly in the patients receiving intravenous sedation, although statistical significance was not shown (p=0.06). Significantly more patients in the intravenous sedation groups reported amnesia (p=0.03). Patient acceptability was good irrespective of the technique used. This study suggests that continuous sedation using propofol or midazolam is not beneficial and should be avoided in ophthalmic patients who have received a simple premedication.