Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia

PURPOSE: To compare the intraoperative pain, anxiety, undesired movement, and cooperation between patients receiving oral diazepam or intravenous (IV) midazolam for conscious sedation during cataract surgery under topical anesthesia. SETTING: Ambulatory surgical center, Honolulu, Hawaii, USA. DESIGN: Prospective randomized controlled trial. METHODS: Patients having first-time cataract extraction with topical anesthesia were randomized to receive sedation with oral diazepam 30 minutes before surgery or IV midazolam immediately preceding surgery. The outcomes of intraoperative pain, anxiety, undesired movement, and poor cooperation were observed by the surgeon and recorded during surgery. RESULTS: One hundred fifty-six cataract surgeries were included, 83 in the IV midazolam group and 73 in the oral diazepam group. Twenty-four patients (29%) in the IV group and 7 patients (10%) in the oral group showed undesired movement (P<.02). Seven patients (8%) in the IV group and 2 patients (3%) in the oral group showed poor cooperation (P>.05). Fifteen patients (18%) in the IV group and 9 patients (12%) in the oral group had anxiety (P>.05). Three patients (4%) in the IV group and 3 patients (4%) in the oral group experienced pain (P>.05). CONCLUSIONS: Fewer patients receiving oral diazepam 30 minutes before cataract surgery than patients receiving IV midazolam immediately preceding surgery showed undesired movement during surgery. There was no statistically significant difference in the number of patients showing poor cooperation or experiencing pain or anxiety between the 2 groups. (C) 2015 ASCRS and ESCRS