[Endocrine stress response in cataract operations with local anesthesia]

This study was undertaken to investigate the endocrine stress response during cataract surgery in local anaesthesia (LA) with or without additional sedation with midazolam (Dormicum). 20 patients for cataract surgery in LA were randomly allocated to the midazolam-group (before injection of LA, sedation with single doses of 1 mg midazolam until the patient was sleeping, but awakeable), and to the control-group without sedation. Premedication and LA were standardized. The investigation was performed at 7 measuring points starting at the arrival in the preparation room up to 30 min after surgery. Adrenaline in plasma was significantly lower in the midazolam-group. Intraoperatively, adrenaline increased in the control-group and decreased in the midazolam-group. In time course, noradrenaline in plasma decreased in the midazolam-group, in contrast to the control-group. With respect to ADH, ACTH and cortisol, no significant differences were found in group levels or time course, and concentrations remained within normal range. In contrast to the control-group, mean arterial pressure decreased in the midazolam-group during the course of time. There were no differences in heart rate or arterial oxygen saturation between the two groups. Local anaesthesia and premedication were sufficient to prevent psychic and surgical stressors. The slight sympathoadrenergic response in the control-group was significantly reduced by small doses of midazolam. Thus, a careful supplementation of local anaesthesia with midazolam appears advantageous for patients with cardiovascular disorders.