Volume 13, Issue 3 (9-2025)
J Surg Trauma 2025, 13(3): 96-102 |
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Zangoue M, Sharafi S, Shaarbaf Yazdi A, Tolyat M. Comparison of the Effects of Melatonin and Midazolam on Hemodynamic Status in Patients Candidate for Cataract Surgery: A Randomized Controlled Clinical Trial. J Surg Trauma 2025; 13 (3) :96-102
URL: http://jsurgery.bums.ac.ir/article-1-483-en.html
URL: http://jsurgery.bums.ac.ir/article-1-483-en.html
School of Allied Medical Sciences. Birjand University of Medical Sciences, Birjand, Iran
Abstract: (278 Views)
Introduction: Maintaining hemodynamic stability during cataract surgery is crucial, particularly in elderly patients or those with underlying medical conditions. Melatonin and midazolam are among the medications used for sedation and improving intraoperative conditions; however, they may have different effects on hemodynamic parameters. This study aimed to compare the impact of these two medications on hemodynamic status before, during, and after cataract surgery.
Methods: This clinical trial was conducted on 40 patients scheduled for cataract surgery under general anesthesia. Participants were randomly assigned to one of two intervention groups; one of which received 0.1 mg/kg of oral melatonin, while the other received 70–80 µg/kg of intravenous midazolam. Both administrations occurred 1 h before surgery. A Saadat monitor was used to record hemodynamic parameters, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), at three intervals: 30 min before the operation, during the operation, and 6 h after the operation. Statistical analysis was performed in SPSS software (version 26), employing a significance threshold of p < 0.05.
Results: Analysis indicated that hemodynamic parameters, including SBP, DBP, and HR, were comparable between the two groups before, during, and after the operation, with no statistically significant intergroup differences (p > 0.05). In contrast, a significant intragroup change was observed in the melatonin group regarding HR over time (p = 0.005).
Conclusion: Although both medications were effective in maintaining hemodynamic stability, melatonin resulted in better stability of HR after surgery, compared to midazolam. Therefore, given its fewer side effects and efficacy on regulating HR, melatonin could be considered a safer alternative for patients prone to tachycardia in cataract surgery.
Methods: This clinical trial was conducted on 40 patients scheduled for cataract surgery under general anesthesia. Participants were randomly assigned to one of two intervention groups; one of which received 0.1 mg/kg of oral melatonin, while the other received 70–80 µg/kg of intravenous midazolam. Both administrations occurred 1 h before surgery. A Saadat monitor was used to record hemodynamic parameters, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), at three intervals: 30 min before the operation, during the operation, and 6 h after the operation. Statistical analysis was performed in SPSS software (version 26), employing a significance threshold of p < 0.05.
Results: Analysis indicated that hemodynamic parameters, including SBP, DBP, and HR, were comparable between the two groups before, during, and after the operation, with no statistically significant intergroup differences (p > 0.05). In contrast, a significant intragroup change was observed in the melatonin group regarding HR over time (p = 0.005).
Conclusion: Although both medications were effective in maintaining hemodynamic stability, melatonin resulted in better stability of HR after surgery, compared to midazolam. Therefore, given its fewer side effects and efficacy on regulating HR, melatonin could be considered a safer alternative for patients prone to tachycardia in cataract surgery.
Type of Study: Research |
Subject:
Ophthalmology
Received: 2025/06/7 | Accepted: 2025/08/13 | ePublished ahead of print: 2025/09/7 | Published: 2025/09/18
Received: 2025/06/7 | Accepted: 2025/08/13 | ePublished ahead of print: 2025/09/7 | Published: 2025/09/18
References
1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614-8. [DOI:10.1136/bjophthalmol-2011-300539]
2. Flessa S. Cataract surgery in low-income countries: a good deal! . Healthcare (Basel). 2022; 10:2580. [DOI:10.3390/healthcare10122580]
3. Han X, Zhang J, Liu Z, Tan X, Jin G, He M, et al. Real-world visual outcomes of cataract surgery based on population-based studies: a systematic review. Br J Ophthalmol. 2023;107(8):1056-65. [DOI:10.1136/bjophthalmol-2021-320997]
4. Lersch F, Eke T. Anaesthesia for cataract surgery. Cataract and Lens Surgery: Springer; 2023. p. 143-58. [DOI:10.1007/978-3-031-05394-8_22]
5. Sanatkar M, Goudarzi M, Espahbodi E. Comparison of the efficacy of two pre-treatment medications of dexmedetomidine-fentanyl and midazolam-fentanyl in cataract surgery. Tehran Univ Med J. 2020;78(3):155-64.
6. Perumal D, Dudley RA, Gan S, Boscardin WJ, Gill A, Gelb AW, et al. Anesthesia care for cataract surgery in Medicare beneficiaries. JAMA Intern Med. 2022;182(11):1171-80. [DOI:10.1001/jamainternmed.2022.4333]
7. Hosni K, Mighri F, Knani L, Mahjoub A, Nouri H, Benjazia K. Efficacy of a premedication with melatonin during cataract surgery under peribulbar block: Study protocol for a prospective randomized double-blinded study. Tunis Med. 2022;100(10):713-18.
8. Ismail SA, Mowafi HA. Melatonin provides anxiolysis, enhances analgesia, decreases intraocular pressure, and promotes better operating conditions during cataract surgery under topical anesthesia. Anesth Analg. 2009;108(4):1146-51. [DOI:10.1213/ane.0b013e3181907ebe]
9. Malekshoar M, Tahmoresi N, Adibi P, Zarei T, Vatankhah M. Investigating the effect of melatonin and tizanidine on hemodynamic parameters and anxiety in patients undergoing cataract surgery: A double-blind randomized clinical trial study. Pars J Med Sci. 2023;21(4):18-25.
10. Khezri MB, Merate H. The effects of melatonin on anxiety and pain scores of patients, intraocular pressure, and operating conditions during cataract surgery under topical anesthesia. Indian J Ophthalmol. 2013;61(7):319-24. [DOI:10.4103/0301-4738.99637]
11. Mahmoudi H, Ebadi A, Salimi SH, Najafi Mehri S, Mokhtari Noori J, Shokrollahi F. Effect of nurse communication with patients on anxiety, depression, and stress level of emergency ward patients. J Crit Care Nurs. 2010;3(1):3-4.
12. Patel T, Kurdi MS. A comparative study between oral melatonin and oral midazolam on preoperative anxiety, cognitive, and psychomotor functions. J Anaesthesiol Clin Pharmacol. 2015;31(1):37-43. [DOI:10.4103/0970-9185.150534]
13. Khademi S, Jouybar R, Ahmadi S, Asmarian N, Ghadimi M, Salari M, et al. Hemodynamic Changes after Continuing or Omitting Regular Angiotensin Converting Enzyme Inhibitors before Cataract Surgery: A Comparative Study. Curr Hypertens Rev. 2023;19(1):59-65. [DOI:10.2174/1573402119666230112110328]
14. Yang L, Li H, Zhao X, Pan Y. Association between cataract surgery and age‐related macular degeneration: a systematic review and meta‐analysis. J Ophthalmol. 2022;2022(1):6780901. [DOI:10.1155/2022/6780901]
15. Zavgorodnia N, Mykhailenko N, Bezugly M, Poplavska I. Effects of phacoemulsification cataract surgery on hydro-and hemodynamics in highly myopic eyes. Bull Probl Biol Med. 2021;159(1):62-6. [DOI:10.29254/2077-4214-2021-1-159-62-66]
16. Hari TS, Sudha TS, Varghese AM, Sasanka KK, Thangaraju P. A study of risk factors and complications in elderly hypertensive subjects. J Family Med Prim Care. 2021;10(6):2230-4. [DOI:10.4103/jfmpc.jfmpc_1959_20]
17. Ono T, Iwasaki T, Kawahara K, Agune Y, Mori Y, Nejima R, et al. Early intervention for perioperative hypertension in cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2023;261(1):147-54. [DOI:10.1007/s00417-022-05815-2]
18. Nazari M, Akbari F, Dehghani A. Comparing the effects of remifentanil with fentanyl on pain intensity, hemodynamic status and post-anesthesia complications of cataract surgery candidates. Medicinal, Psychological, and Health Research Journal . 2025;1(4):116-25.
19. Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C. Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg. 2005;101(5):1427-32. [DOI:10.1213/01.ANE.0000180200.11626.8E]
20. Haddadi S, Shahrokhirad R, Ansar MM, Marzban S, Akbari M, Parvizi A. Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery. Aapm. 2018;8(5):39-43. [DOI:10.5812/aapm.61041]
21. Pechanova O, Paulis L, Simko F. Peripheral and central effects of melatonin on blood pressure regulation. Int J Mol Sci. 2014;15(10):17920-37. [DOI:10.3390/ijms151017920]
22. Kadhim Alkidsawi MJ, Hussein HA, Alhamaidah MF, Mahdi AH, Kahloul M. Investigating the Influence of Melatonin on the Respiratory Rate, Heart Rate, and Oxygen Saturation in Paediatric Surgical Care: A Randomized Double-Blinding Trial. Pak J Life Soc Sci. 2024;22(1):2065. [DOI:10.57239/PJLSS-2024-22.1.00151]
23. marzban s, haddadi s, taheri fard p, atrkar roshan z, parvizi a, panjtan panah m. Comparison of the effect of Melatonin and Gabapentin on pain and anxiety in patients undergoing cataract surgery with Phacoemulsification with topical anesthesia. Anesthesiology and Pain. 2016;7(3):1-10.
24. Mowafi HA, Ismail SA. Melatonin improves tourniquet tolerance and enhances postoperative analgesia in patients receiving intravenous regional anesthesia. Anesthesia & Analgesia. 2008;107(4):1422-6. [DOI:10.1213/ane.0b013e318181f689]
25. Baker J, Kimpinski K. Role of melatonin in blood pressure regulation: An adjunct anti‐hypertensive agent. Clin Exp Pharmacol Physiol. 2018;45(8):755-66. [DOI:10.1111/1440-1681.12942]
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