Cataract Surgery in Daytona Beach
Analysis finds MKO Melt controls pain and anxiety during cataract surgery.
After an analysis of 610 patients, the MKO Melt was found to be an effective means for controlling pain and anxiety during cataract surgery, with the advantage of reducing the need for IV medications.
My colleagues and I at Avanti Anesthesia and the Eye Center of Texas at Kirby Glen Surgery Center designed a prospective, controlled analysis of patients undergoing cataract surgery to compare the conscious sedation efficacy of the MKO Melt (Imprimis Pharmaceuticals) to what we were already giving our patients. Of par- ticular interest was the possibility of improving the patient experience dur- ing cataract surgery by not requiring an IV to deliver conscious sedation.
Patients were randomly assigned to one of three groups. Group 1 received oral valium (5 mg or 10 mg), group 2 received oral diazepam (5 mg or 10 mg), oral tramadol (50 mg or 100 mg) and sublingual ondansetron (4 mg) and group 3 received one to two sub- lingual MKO Melts. Each MKO Melt contains a mixture of 3 mg midazolam, 25 mg ketamine and 2 mg ondansetron and is administered under the tongue.
We found that, across all groups, additional IV medications were required 32.1% of the time, which is similar to other published studies. Furthermore, we found no significant difference between surgical or discharge times across patient groups, surgeon or patient satisfaction, or side effect profile between groups. Long axial length was not associated with a higher incidence of pain or the administration of medications for pain. Patients with pre-existing psychiatric diagnoses and current use of narcotics or benzodiazepines did not require a statistically increased amount of IV medications. Patients were called the day after surgery and reported high satisfaction, and no significant post-discharge side effects were reported across all groups.
Patients with pre-existing psychiatric diagnoses and current use of narcotics or benzodiazepines did not require a statistically significant increased amount of IV medications. There were no documented cases of intraoperative bradycardia or other complications that necessitated treat- ment. Patients were called the day after surgery and reported high satisfaction, and no significant post-discharge side effects were reported across all groups.
Our first and perhaps most important clinical conclusion is that MKO Melt is safe. After having personally admin- istered this drug to a few thousand patients, I have encountered no adverse events requiring the use of IV medications.
Second, it is possible to offer the MKO Melt in lieu of an IV for cataract surgery, as many centers across the country have done. We have found that there is a high chance of success with such a program if the surgeon has fast surgical times, uses intracameral lidocaine and does not mind talking the patient through the procedure if needed.
We estimate that as we gain experience with the MKO Melt, less than 15% of our patients will require IV medications after receiving it. Predicting which patients will need IV sedation is fairly straightforward. Patients with high levels of anxiety, such as those that had difficulty during their presurgical testing or do not tolerate eyedrops well, should get an IV for their surgery. After about 100 procedures, the anesthesia and nursing teams had learned the proper dosing, the timing and how to coach patient expectations. In our opinion, having an anesthesia provider present is more important than having an IV, which, in most patients, can be easily placed when needed. In fact, if you survey the nursing, anesthesia and surgical colleagues at our surgical center, MKO Melt is the preferred medication for sedation of cataract patients (as well as retina patients).
Our analysis of the MKO Melt showed that it is safe, effective and superior to diazepam in the reduction of anxiety and need for IV medications. Once integrated into daily practice, MKO Melt becomes a valuable tool for cataract surgery.
For more information on Cataract Surgery in Daytona Beach, please contact the Precision Eye Institute.
This article was re-posted from an article by Maggie Jeffries, MD