Dexmedetomidine Causes Increased Hypotension in Older Adults When Used for Cataract Surgery Compared to Propofol

Abstract

Purpose: This study evaluated the hemodynamic effects, suitability and safety of dexmedetomidine (DEX) compared with propofol (PRO) in older adults having outpatient cataract surgery under monitored anesthesia care. The patients, surgeon and the anesthesia staff evaluated satisfaction for both drugs.Method: This prospective, single blind, randomized study was conducted using forty-seven patients ≥55 years old undergoing cataract surgery. The two patient groups received either i.v. dexmedetomidine 1 μg/kg over 10 min; followed by maintenance i.v. infusion at 0.2 -0.7 μg/kg/hr (DEX group, N = 24), or propofol infused between 25 -120 μg/kg/min (PRO group, N = 23). Both agents were titrated to patient comfort. Results: Patients’ mean arterial pressures (SEM) at baseline were 104.7 (2.6) and 107.5 (2.7) mmHg for the DEX and PRO groups, respectively (p = 0.45). At discharge the pressures were 78.1 (2.5) and 98.1 (2.6) mmHg in DEX and PRO groups, respectively (p 0.05). Patients’ heart rates (SEM) at baseline were 74.8 (3.0) for the DEX group and 73.2 (2.8) bpm for the PRO groups (p = 0.71). At the time of discharge following surgery, the mean heart rate for the DEX group was 61.5 (2.2) bpm vs. 69.1 (2.3) bpm (p 0.05) for the PRO group. Three patients in the DEX group developed complications precluding discharge or requiring readmission while none of the patience in the PRO group had complications (p = 0.08). Patient and surgeon satisfaction scores were similar between the groups. Conclusion: Dexmedetomidine is a less suitable sedative compared with propofol use in older patients undergoing cataract surgery due to the decrease in hemodynamic parameters and noted increases in complication rates.