白内障手術におけるα2作動性鎮静薬（デクスメデトミジン）の有用性

Sedation with dexmedetomidine, an alpha-2 adrenergic antagonist, for cataract surgery

要約　目的：α₂作動性鎮静薬（デクスメデトミジン）を使用した鎮静下白内障手術の成績報告。

対象と方法：過去1年間に，白内障手術に際しデクスメデトミジンにて鎮静を行ったのべ63例（男性25例，女性38例，平均年齢77.6歳）について周術期の状況を解析した。

結果：選択理由は軽度の認知症32例，安定している精神疾患18例，軽度の知的障害3例など，外来診察は可能であるが，術中の安静が困難と判断した症例であった。循環動態が安定しなかった1例と，極量投与でも鎮静が得られなかった1例を除き，手術は安全に実施できた。全例において術中，術後の合併症はない。全身麻酔に比べ，手術室での所要時間は有意に短縮できた。

結論：白内障手術においてデクスメデトミジンでの鎮静は安全で有用な方法といえる。

Abstract　Purpose：To report the use of dexmedetomidine, an alpha-2 adrenergic antagonist, for sedation during cataract surgery.

Cases and Method：This retrospective study was made on 63 patients who received cataract surgery under sedation by dexmedetomicine during the past 12 months. The series comprised 25 males and 38 females. The age averaged 77.6 years. Sedation during surgery was needed due to mild senile dementia in 32 cases, psychiatric disorders in 18 cases, hearing difficulty in 5 cases, and mild mental retardation in 3 cases among others. These cases could be examined in the outpatient clinic, but were regarded as unfit for cataract surgery under local anesthesia only.

Results：Cataract surgery was safely performed in 61 cases with no adverse events during or after operation. Surgery had to be discontinued in 2 cases. One showed unstable hemodynamic state and the other could not be sedated with maximal dose of dexmedetomidine. Cataract surgery in the 61 eyes resulted in shorter stay in the surgical room as compared with surgery under general anesthesia.

Conclusion：Cataract surgery under sedation by dexmedetomidine was safe and effective in the majority of cases in the present series.