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The Influence of Low-Dose Dexmedetomidine on Recovery Times Following Sedation for Vitreoretinal Surgery: A Retrospective Cohort Study
Journal article   Peer reviewed

The Influence of Low-Dose Dexmedetomidine on Recovery Times Following Sedation for Vitreoretinal Surgery: A Retrospective Cohort Study

Richard H Epstein, Franklin Dexter and Steven Gayer
Anesthesia and analgesia
11/25/2025
DOI: 10.1213/ANE.0000000000007859
PMID: 41810884

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Abstract

Dexmedetomidine for procedural sedation during ophthalmic surgery is popular, in part due to high levels of patient satisfaction and analgesia, and low intraocular pressure and respiratory depression, compared to alternative medications. However, longer recovery times were reported when dexmedetomidine was used for cataract or vitreoretinal surgery. Because of these reports, a concern was raised by our hospital's retinal surgeons and administrators that dexmedetomidine might be delaying discharge home from the postanesthesia care unit. Therefore, we performed a retrospective analysis of discharge times of all patients undergoing vitreoretinal surgery under regional anesthesia and sedation at our high-volume ophthalmology specialty hospital. Data from all cases involving vitreoretinal surgery in adults performed with sedation were extracted from the hospital's electronic health record system. Discharge times were calculated from the end of surgery (eye dressings applied) until discharge home from the phase II postanesthesia care unit. Using general linear models, discharge times were compared between patients who received dexmedetomidine or other medications for sedation between fiscal year (July 1 to June 30) 2020 and fiscal year 2024. The modeling controlled for interactions between sedation group and year, and included the anesthesia clinician administering the sedation as a fixed effect. The fraction of cases during which dexmedetomidine was used for sedation during vitreoretinal surgery increased progressively from <0.7% in 2019 to 91.3% by 2023. Among the 6180 cases with dexmedetomidine, the mean (standard deviation ) dose of dexmedetomidine, normalized for body weight and the interval from entering the operating room to the end of surgery, was 0.24 (0.20) µg/kg/h. Intermittent bolus doses were administered without infusion in 96.3% of cases. The mean discharge time among the dexmedetomidine cases did not differ significantly from the 2274 cases without dexmedetomidine (-2.04 minutes; 95% confidence interval, -5.71 to 1.65 minutes; P = .28). A low-dose, bolus dexmedetomidine technique did not prolong the time to home discharge when administered for sedation during vitreoretinal surgery. Managerial concerns about such use prolonging discharge times following vitreoretinal surgery are unwarranted.

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