Patient Satisfaction with Oral versus Intravenous Sedation for Cataract Surgery: A Randomized Clinical Trial

• Published in: Ophthalmology (Rochester, Minn.) Vol. 126; no. 9; pp. 1212 - 1218
• Main Authors: Peeler, Crandall E, Villani, Catherine M, Fiorello, Marissa G, Lee, Hyunjoo J, Subramanian, Manju L
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Administration, Oral; Aged; Anesthetics, Intravenous; Anesthetics, Local - administration & dosage; Conscious Sedation - methods; Double-Blind Method; Eye Pain - physiopathology; Eye Pain - prevention & control; Female; Humans; Hypnotics and Sedatives - administration & dosage; Lens Implantation, Intraocular; Male; Midazolam - administration & dosage; Middle Aged; Pain Measurement; Patient Satisfaction - statistics & numerical data; Phacoemulsification; Prospective Studies; Triazolam - administration & dosage
• ISSN: 1549-4713
• DOI: 10.1016/j.ophtha.2019.04.022

To determine whether patient satisfaction with oral sedation is noninferior to intravenous sedation for cataract surgery. Prospective, randomized, double-masked clinical trial. A volunteer sample of patients 18 years or older from diverse backgrounds scheduled for cataract surgery. Patients who were allergic to benzodiazepines, older than 70 years with a failed delirium screening questionnaire, pregnant or nursing, using a medication inhibiting cytochrome 450 3A, or intoxicated on the day of surgery were excluded. Patients were randomized to receive either oral triazolam with intravenous placebo or intravenous midazolam with oral placebo before surgery. The primary outcome was patient satisfaction, measured by a survey administered on postoperative day 1. Secondary outcomes included surgeon and anesthesia provider satisfaction, need for supplemental anesthesia, and surgical complications. Among the 85 patients (42 men [49.4%]; mean age, 65.8 years; standard deviation, 9.5 years) completing the study, the mean satisfaction score was 5.34±0.63 (range, 3.75-6) in the oral sedation group and 5.40±0.52 (range, 4-6) in the intravenous group. With an a priori noninferiority margin of 0.5 and a difference in mean scores between the 2 groups of 0.06 (1-tailed 95% confidence interval [CI], -infinity to 0.27), our results demonstrate noninferiority of oral sedation with a P value of 0.0004. Surgeon and anesthesia provider satisfaction was similar between the 2 groups. Intraoperative complications occurred in 16.7% in the oral group and 9.3% in the intravenous group (difference, 7.4%; 95% CI, -6.9% to 21.6%; P = 0.31). The only major intraoperative complication-a posterior capsular tear-occurred in the intravenous group. Eight patients in the oral group (19.0%) and 3 in the intravenous group (7.0%) received supplemental intravenous sedation (difference, 12.1%; 95% CI, -2.0% to 26.2%; P = 0.097). The use of oral sedation in cataract surgery has been suggested as a cost- and space-saving measure, potentially allowing the transition of some patients from an operating to procedure room or office-based setting. We report the noninferiority of oral compared with intravenous sedation for cataract surgery in a diverse patient population in terms of patient satisfaction.