Assessing intravenous midazolam for conscious sedation during cataract surgery

Madhuri V. Dhabarde, Archana S. Mhatre, Abhijeet D. Waychal, Deepanjali P. Patankar


Background: A large number of geriatric populations above the age of 50 worldwide suffer from cataract. Cataract starts with short-sightedness and gradually worsens resulting in blurring of vision and inability to visualize and distinguish fine details. Surgery is the only available treatment for cataract. Anaesthesia is essential during cataract surgery to minimize pain caused during surgical procedure and to achieve favourable surgical outcome. The current investigation was aimed towards assessing the performance of intravenous midazolam used for conscious sedation during cataract surgery along with retrobulbar block.

Methods: Current study is a randomized double blinded study performed for duration of 6 months on 60 patients undergoing cataract surgery at Terna medical college and hospital. Patients were divided in two groups; group M received 0.02 mg/kg midazolam diluted to 5 ml, group N received 5 ml normal saline before cataract surgery. All vital hemodynamic parameters were observed after 5 minutes of sedation, immediately after block administration and after every 15 minutes till the end of the surgery to assess the effect of sedation. Patients and surgeons satisfaction levels were also documented post-surgery.

Results: Patients who were sedated with midazolam prior to cataract surgery along with block exhibited a significant decrease in hemodynamic parameters like SAP, DAP and heart rate which indicated effective sedation. Anxiety level also significantly decreased in the patients who received midazolam. No major adverse or intra-operative events were observed in the patients who received midazolam.

Conclusions: Sedation with midazolam provides haemodynamic conditions favourable for cataract surgery along with high level of patient and surgeon satisfaction.


Cataract surgery, Anaesthesia, Midazolam, Hemodynamic parameters, Sedation, Benzodiazepines, Retrobulbar block

Full Text:



Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: an appraisal. Indian J Ophthalmol. 2014;62(2):103-10.

Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017;390(10094):600-12.

Allen D. Cataract. BMJ Clin Evid. 2011;2011:708.

Thompson J, Lakhani N. Cataracts. Prim Care. 2015;42(3):409-23.

Murthy G, Gupta SK, John N, Vashist P. Current status of cataract blindness and Vision 2020: The right to sight initiative in India. Indian J Ophthalmol. 2008;56:489-94.

Kupfer C. The conquest of cataract: A global challenge. Trans Ophthalmol Soc UK. 1985;104:1-10.

Allen D, Vasavada A. Cataract and surgery for cataract. BMJ. 2006;333(7559):128-32.

Snellingen T, Evans JR, Ravilla T, Foster A. Surgical interventions for age related cataract. Cochrane Database Syst Rev. 2002;(2):CD001323.

Shah R. Anesthesia for cataract surgery: Recent trends. Oman J Ophthalmol. 2010;3(3):107-08.

Bellucci R. Anesthesia for cataract surgery. Curr Opin Ophthalmol. 1999;10(1):36-41.

Khokhar S, Gupta S, Ganguly A, Shende D. Prevalence and indications of general anesthesia for adult cataracts in a tertiary care centre in India. Indian J Anaesth. 2014;58(2):231-2.

Nouvellon E, Cuvillon P, Ripart J, Viel EJ. Anaesthesia for cataract surgery. Drugs Aging. 2010;27(1):21-38.

Thevi T, Godinho MA. Trends and complications of local anaesthesia in cataract surgery: an 8-year analysis of 12 992 patients. Br J Ophthalmol. 2016 Dec;100(12):1708-13.

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.

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.

Muttu S, Liu EH, Ang SB, Chew PT, Lee TL, Ti LK. Comparison of dexmedetomidine and midazolam sedation for cataract surgery under topical anesthesia. J Cataract Refract Surg. 2005;31(9):1845-6.

Virkkilä ME, Ali-Melkkilä TM, Kanto JH. Premedication for outpatient cataract surgery: a comparative study of intramuscular alfentanil, midazolam and placebo. Acta Anaesthesiol Scand. 1992;36(6):559-63.

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.

Shah R. Anesthesia for cataract surgery: Recent trends. Oman J Ophthalmol. 2010;3(3):107–8.

Gollogly HE, Hodge DO, St Sauver JL, Erie JC. Increasing incidence of cataract surgery: population-based study. J Cataract Refract Surg. 2013;39(9):1383-9.

Song P, Wang H, Theodoratou E, Chan KY, Rudan I. The national and subnational prevalence of cataract and cataract blindness in China: a systematic review and meta-analysis. J Glob Health. 2018;8(1):010804.

Cok OY, Ertan A, Bahadir M. Comparison of midazolam sedation with or without fentanyl in cataract surgery. Acta Anaesthesiol Belg. 2008;59(1):27-32.

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.

Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, Fleisher LA, Schein OD. Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. The Study of Medical Testing for Cataract Surgery study team. Ophthalmology. 2000;107(11):2054-60.

Kost M, Emerson D. Propofol-fentanyl versus midazolam-fentanyl: a comparative study of local sedation techniques for cataract surgery. CRNA. 1992;3(1):7-15.

Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth. 2006;96(6):722-6.