Dexmetomidine Versus Remifentanil Monitored Anesthesia Care During Endothelial Keratoplasty: A Retrospective Study.

Endothelial Keratoplasties (EKs) are usually performed under topical or locoregional anesthesia.

Sedation is administered to avoid anxiety or uncontrolled and unexpected movements.

Drugs used sedation during EKs are propofol midazolam, and the opioids remifentanil. Each of these drugs can cause respiratory depression, hypoxemia, and apnea.

Dexmedetomidine is an alpha-2 adrenoreceptor agonist with sedative, analgesic and anxiolytic properties with minimal respiratory depression; it decreases intraocular pressure (IOP) and pain during the local anesthetic injection.

The current study aimed to compare clinical outcomes, feasibility and patients’ and surgeons’ satisfaction intraoperative sedation with dexmedetomidine versus remifentanil during EKs.

Retrospective, observational, single-center study. The study was performed at the Eye Clinic, Department of Surgery and Translational Medicine, of the University of Florence.

Patients who underwent EKs under locoregional anesthesia during the period from September 2021 to February 2022 and received sedation with dexmedetomidine or remifentanil were enrolled.

In patients undergoing sedation, heart rate, systolic and diastolic blood pressure, respiratory rate, oxygen saturation are always recorded at baseline and every 10 minutes until the end of surgery. The degree of sedation is evaluated using the Ramsay sedation scale.

Preoperative evaluation of anxiety disorders is carried out with the Hospital Anxiety and Depression Scale (HADS), while patients’ and surgeon’s satisfaction is evaluated with the 7-point Likert-like verbal rating scale.

A total of 44 patients met the inclusion criteria in the study period.

Twenty-four (group 1) received a continuous dexmedetomidine intravenous infusion, while 20 (group 2) received remifentanil.

There was no statistically difference in the hemodynamic (HR, SBP, DBP) and respiratory (Sp02, RR) parameters between the two groups before, during and at the end of surgery.

The mean value of Ramsay scale reached with dexdor was 3 (patient co-operative and oriented) and 2 (responds to command only) with remifentanil.

Both patients and surgeons reported higher satisfaction scores with dexdor compared to patients receiving remifentanil (respectively 7 and 7 versus 5 and 4 in the 7-point Likert-like verbal rating scale).

The use of sedative-hypnotic agents and analgesics is an integral part of comfort and safety of patients undergoing EK surgery.

With the same stability of hemodynamic and respiratory parameters, dexmedetomidine provided deeper sedation than remifentanil without respiratory depression, guaranteeing a better surgical performance in terms of patients’ and surgeon’s satisfaction, thus suggesting a key role in sedation during Ek surgery.