Comparison of the Effects of Dexmedetomidine and Remifentanil on Cognition State After Cataract Surgery

Mahtab Poorzamany Nejat Kermany; Mastaneh Dahi; Reyhaneh Yamini Sharif; Badiozaman Radpay

doi:10.5812/aapm.33448

Comparison of the Effects of Dexmedetomidine and Remifentanil on Cognition State After Cataract Surgery

Anesth Pain Med. 2016 May 9;6(3):e33448. doi: 10.5812/aapm.33448. eCollection 2016 Jun.

Authors

Mahtab Poorzamany Nejat Kermany¹, Mastaneh Dahi², Reyhaneh Yamini Sharif³, Badiozaman Radpay⁴

Affiliations

¹ Department of Anesthesiology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Department of Anesthesiology, Taleghani Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Anesthesiology, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Anesthesiology, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: Dexmedetomidine is a potent and highly specific α2-adrenoreceptor agonist that induces sedative and analgesic effects over a short-term period. As a result of these benefits, dexmedetomidine may be a better alternative than other available drugs for keeping the patient's cognition state in an acceptable condition after outpatient ophthalmic surgeries.

Objectives: This randomized study was conducted to compare the sedative effects of dexmedetomidine and remifentanil on the cognitive state of patients who have undergone cataract surgery.

Patients and methods: A total of 100 patients who were candidates for cataract surgery under local anesthesia received either dexmedetomidine (50 patients; D group) or remifentanil (50 patients; R group) in a double-blind, randomized study. The baseline cardiovascular status and mini mental state examination (MMSE) score for each patient were recorded. As a loading dose, dexmedetomidine (0.5 µg/kg) and remifentanil (0.1 µg/kg) were infused at 10 minutes and 5 minutes before topical anesthesia, respectively. Subsequently, the maintenance dose was administered at 0.2 µg/kg/hour and 0.05 µg/kg/minutes in the D and R groups, respectively. The surgical procedure was begun when the bispectral index (BIS) reached 70 - 80. MMSE test was done at a postanesthetic care unit (PACU) 120 minutes after the discontinuation of the drug.

Results: There was no statistically significant difference between the MMSE scores of the two groups before surgery (P = 0.6), but the MMSE test conducted at the PACU revealed significantly better cognitive outcomes in the D group than in the R group in patients younger and older than 65 years (P = 0.03 and P = 0.0001, respectively).

Conclusions: This study revealed that dexmedetomidine may be a suitable agent for sedation in cataract surgery because it results in a more favorable postoperative cognitive status than remifentanil. Likewise, dexmedetomidine had no significant adverse effects on cardiovascular or respiratory systems.

Keywords: Cataract Surgery; Cognitive Disorder; Sedative Drug.