The effect of propofol-midazolam versus sevoflurane on bispectral index and eye position in pediatric cataract surgery: A randomized controlled study

ABSTRACT

Background

Cataract surgery is one of the infrequent ocular surgeries. The adequate ocular position with central alignment is the main prerequisite for good surgical technique. Propofol and sevoflurane are the common anesthetics drugs used during pediatric anesthesia. BIS monitor is one of the common intraoperative awareness monitors used.

Aim

To assess the efficacy of the bispectral index monitor in quantifying the depth of anesthesia and its correlation with ocular alignment during juvenile cataract surgery. Specifically, we will compare the use of sevoflurane anaesthesia with total intravenous anesthesia using a midazolam bolus and propofol infusion.

Methods

This study included 100 children scheduled for cataract surgery. The children were divided into two groups: group (S) included 50 children who were anesthetized using sevoflurane maintenance only and group (P) included 50 children who were anesthetized using continuous intravenous anesthesia (midazolam bolus plus propofol infusion) as maintenance after induction with sevoflurane anesthesia 8%. The bispectral index was recorded immediately after induction and after intubation and every 5 min later on until end of surgery.

Results

The eye position showed statistically significant central position among the propofol group with p value 0.02. An eye position-BIS value association was found statistically significant negative correlation in sevoflurane group while no statistically significant link was found in the propofol group.

Conclusion

Use of BIS monitor for making correlation between depth of anesthesia for prediction of ocular alignment was significant in sevoflurane group, but not in propofol group in pediatric patients and even with adequate depth of general anesthesia.

KEYWORDS:

• Bispectral index monitoring
• pediatric cataract
• propofol-midazolam
• sevoflurane

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/11101849.2024.2344747

Clinical trial registration number

The study protocol was registered at clinical trials.gov on (date 2/3/2022) with unique ID NTC05262205.

IRB number

The Institutional Research Board, Faculty of Medicine, Mansoura University approved the study protocol on 13 April 2021 (IRB code: MD21.03.449).