Anesthesiology and Pain Medicine

Published by: Neoscriber Demo Publisher

Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

Leili Adinehmehr ORCID 1 , Hamidreza Shetabi ORCID 1 , * , Darioush Moradi Farsani ORCID 1 , Ali Salehi 2 and Mohadese Noorbakhsh 3
Authors Information
1 Anesthesiology and Critical Care Department, Isfahan University of Medical Sciences, Isfahan, Iran
2 Ophthalmology Department, Isfahan University of Medical Sciences, Isfahan, Iran
3 Isfahan University of Medical Sciences, Isfahan, Iran
Article information
  • Anesthesiology and Pain Medicine: April 30, 2019, 9 (2); e87415
  • Published Online: April 27, 2019
  • Article Type: Research Article
  • Received: December 11, 2018
  • Revised: March 23, 2019
  • Accepted: March 28, 2019
  • DOI: 10.5812/aapm.87415

To Cite: Adinehmehr L, Shetabi H, Moradi Farsani D , Salehi A, Noorbakhsh M. Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial, Anesth Pain Med. 2019 ; 9(2):e87415. doi: 10.5812/aapm.87415.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Micieli JA, Arshinoff SA. Cataract surgery. CMAJ. 2011;183(14):1621. doi: 10.1503/cmaj.110549. [PubMed: 21825045]. [PubMed Central: PMC3185079].
  • 2. Foster A. Vision 2020: The cataract challenge. Community Eye Health. 2000;13(34):17-9. [PubMed: 17491949]. [PubMed Central: PMC1705965].
  • 3. Shah R. Anesthesia for cataract surgery: Recent trends. Oman J Ophthalmol. 2010;3(3):107-8. doi: 10.4103/0974-620X.71881. [PubMed: 21120044]. [PubMed Central: PMC2992155].
  • 4. Zhao LQ, Zhu H, Zhao PQ, Wu QR, Hu YQ. Topical anesthesia versus regional anesthesia for cataract surgery: A meta-analysis of randomized controlled trials. Ophthalmology. 2012;119(4):659-67. doi: 10.1016/j.ophtha.2011.09.056. [PubMed: 22365066].
  • 5. Waheeb S. Topical anesthesia in phacoemulsification. Oman J Ophthalmol. 2010;3(3):136-9. doi: 10.4103/0974-620X.71892. [PubMed: 21120050]. [PubMed Central: PMC2992161].
  • 6. Eke T, Thompson JR. Serious complications of local anaesthesia for cataract surgery: A 1 year national survey in the United Kingdom. Br J Ophthalmol. 2007;91(4):470-5. doi: 10.1136/bjo.2006.106005. [PubMed: 17124243]. [PubMed Central: PMC1994745].
  • 7. Chandrasekhara Reddy S, Thevi T. Local anaesthesia in cataract surgery. Int J Ophthalmic Res. 2017;3(1):204-10. doi: 10.17554/j.issn.2409-5680.2017.03.59.
  • 8. Dadaci Z, Borazan M, Oncel Acir N. Pain perception in phacoemulsification with topical anesthesia and evaluation of factors related with pain. Turk J Ophthalmol. 2016;46(4):151-5. doi: 10.4274/tjo.13914. [PubMed: 28058148]. [PubMed Central: PMC5200818].
  • 9. Habib NE, Mandour NM, Balmer HG. Effect of midazolam on anxiety level and pain perception in cataract surgery with topical anesthesia. J Cataract Refract Surg. 2004;30(2):437-43. doi: 10.1016/S0886-3350(03)00557-1. [PubMed: 15030838].
  • 10. Zhang F, Sun HR, Zheng ZB, Liao R, Liu J. Dexmedetomidine versus midazolam for sedation during endoscopy: A meta-analysis. Exp Ther Med. 2016;11(6):2519-24. doi: 10.3892/etm.2016.3186. [PubMed: 27284342]. [PubMed Central: PMC4887952].
  • 11. Woo JH, Au Eong KG, Kumar CM. Conscious sedation during ophthalmic surgery under local anesthesia. Minerva Anestesiol. 2009;75(4):211-9. [PubMed: 18987568].
  • 12. Aydin ON, Kir E, Ozkan SB, Gursoy F. Patient-controlled analgesia and sedation with fentanyl in phacoemulsification under topical anesthesia. J Cataract Refract Surg. 2002;28(11):1968-72. [PubMed: 12457671].
  • 13. Sanri E, Karacabey S, Akoglu H, Kaya B, Guneysel O. Comparison of ketamine/propofol (ketofol) and etomidate/fentanyl (etofen) combinations for procedural sedation and analgesia in the emergency department: An observational study. Turk J Emerg Med. 2017;17(3):89-94. doi: 10.1016/j.tjem.2017.01.003. [PubMed: 28971155]. [PubMed Central: PMC5608606].
  • 14. Chen M, Hill GM, Patrianakos TD, Ku ES, Chen ML. Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia. J Cataract Refract Surg. 2015;41(2):415-21. doi: 10.1016/j.jcrs.2014.06.027. [PubMed: 25661136].
  • 15. Loots H, Wiseman R. Agents for sedation in ophthalmic surgery: A review of the pharmacodynamics and clinical applications. Curr Anaesth Crit Care. 2006;17(3-4):179-90. doi: 10.1016/j.cacc.2006.09.001.
  • 16. Ferrari LR, Donlon JV. A comparison of propofol, midazolam, and methohexital for sedation during retrobulbar and peribulbar block. J Clin Anesth. 1992;4(2):93-6. [PubMed: 1562343].
  • 17. Rewari V, Madan R, Kaul HL, Kumar L. Remifentanil and propofol sedation for retrobulbar nerve block. Anaesth Intensive Care. 2002;30(4):433-7. doi: 10.1177/0310057X0203000405. [PubMed: 12180580].
  • 18. Banihashem N, Alijanpour E, Basirat M, Shokri Shirvany J, Kashifard M, Taheri H, et al. Sedation with etomidate-fentanyl versus propofol-fentanyl in colonoscopies: A prospective randomized study. Caspian J Intern Med. 2015;6(1):15-9. [PubMed: 26221491]. [PubMed Central: PMC4478113].
  • 19. Keim SM, Erstad BL, Sakles JC, Davis V. Etomidate for procedural sedation in the emergency department. Pharmacotherapy. 2002;22(5):586-92. [PubMed: 12013357].
  • 20. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91. [PubMed: 7772368].
  • 21. Hatamabadi HR, Arhami Dolatabadi A, Derakhshanfar H, Younesian S, Ghaffari Shad E. Propofol versus midazolam for procedural sedation of anterior shoulder dislocation in emergency department: A randomized clinical trial. Trauma Mon. 2015;20(2). e13530. doi: 10.5812/traumamon.13530. [PubMed: 26290851]. [PubMed Central: PMC4538724].
  • 22. Rahman NH, Hashim A. The use of propofol for procedural sedation and analgesia in the emergency department: A comparison with midazolam. Emerg Med J. 2011;28(10):861-5. doi: 10.1136/emj.2009.085019. [PubMed: 21098799].
  • 23. Taylor DM, O'Brien D, Ritchie P, Pasco J, Cameron PA. Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation. Acad Emerg Med. 2005;12(1):13-9. doi: 10.1197/j.aem.2004.08.039. [PubMed: 15635132].
  • 24. Hari Keerthy P, Balakrishna R, Srungeri KM, Singhvi N, John J, Islam M. Comparitive evaluation of propofol and midazolam as conscious sedatives in minor oral surgery. J Maxillofac Oral Surg. 2015;14(3):773-83. doi: 10.1007/s12663-014-0676-y. [PubMed: 26225076]. [PubMed Central: PMC4510082].
  • 25. Toklu S, Iyilikci L, Gonen C, Ciftci L, Gunenc F, Sahin E, et al. Comparison of etomidate-remifentanil and propofol-remifentanil sedation in patients scheduled for colonoscopy. Eur J Anaesthesiol. 2009;26(5):370-6. doi: 10.1097/EJA.0b013e328318c666. [PubMed: 19300267].
  • 26. Dickinson R, Singer AJ, Carrion W. Etomidate for pediatric sedation prior to fracture reduction. Acad Emerg Med. 2001;8(1):74-7. [PubMed: 11136155].
  • 27. Moerman AT, Foubert LA, Herregods LL, Struys MM, De Wolf DJ, De Looze DA, et al. Propofol versus remifentanil for monitored anaesthesia care during colonoscopy. Eur J Anaesthesiol. 2003;20(6):461-6. [PubMed: 12803263].
  • 28. Aghadavoudi O, Dehghan M, Montazeri K. [Comparison the effects of etomidate infusion versus ketamine-midazolam-fentanyl combination in sedation for cataract surgery]. J Isfahan Med Sch. 2013;31(255). Persian.
  • 29. Choi YF, Wong TW, Lau CC. Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation. Emerg Med J. 2004;21(6):700-2. doi: 10.1136/emj.2002.004143. [PubMed: 15496697]. [PubMed Central: PMC1726487].
  • 30. Vinson DR, Bradbury DR. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med. 2002;39(6):592-8. [PubMed: 12023700].
  • 31. Di Liddo L, D'Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C. Etomidate versus midazolam for procedural sedation in pediatric outpatients: A randomized controlled trial. Ann Emerg Med. 2006;48(4):433-40. 440 e1. doi: 10.1016/j.annemergmed.2006.03.004. [PubMed: 16997680].
  • 32. Bellolio MF, Gilani WI, Barrionuevo P, Murad MH, Erwin PJ, Anderson JR, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: A systematic review and meta-analysis. Acad Emerg Med. 2016;23(2):119-34. doi: 10.1111/acem.12875. [PubMed: 26801209]. [PubMed Central: PMC4755157].
  • 33. Forman SA. Clinical and molecular pharmacology of etomidate. Anesthesiology. 2011;114(3):695-707. doi: 10.1097/ALN.0b013e3181ff72b5. [PubMed: 21263301]. [PubMed Central: PMC3108152].
  • 34. Fanti L, Agostoni M, Gemma M, Gambino G, Facciorusso A, Guslandi M, et al. Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: A randomized double-blind trial. Am J Gastroenterol. 2009;104(5):1119-24. doi: 10.1038/ajg.2009.53. [PubMed: 19337241].
  • 35. Ho WM, Yen CM, Lan CH, Lin CY, Yong SB, Hwang KL, et al. Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: A prospective, randomized study. BMC Gastroenterol. 2012;12:164. doi: 10.1186/1471-230X-12-164. [PubMed: 23170921]. [PubMed Central: PMC3607964].
  • 36. Aghadavoudi O, Balaei P, Akbari M. [The comparison of the efficacy and safety of sedation with etomidate-fentanyl versus ketamine-midazolam combinations in cataract surgery]. J Isfahan Med Sch. 2012;30(209). Persian.
  • 37. Lee-Jayaram JJ, Green A, Siembieda J, Gracely EJ, Mull CC, Quintana E, et al. Ketamine/midazolam versus etomidate/fentanyl: Procedural sedation for pediatric orthopedic reductions. Pediatr Emerg Care. 2010;26(6):408-12. doi: 10.1097/PEC.0b013e3181e057cd. [PubMed: 20502386].
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