Oral vs IV Sedation for Cataract Surgery in Older Adults

This clinical trial is designed to compare two common ways of providing sedation during cataract surgery in older adults: oral sedation (a pill) and intravenous (IV) sedation (medicine given through a vein). Cataract surgery is a quick and safe procedure that helps people see better by removing the cloudy lens in their eye. While numbing eye drops are routinely used to prevent pain, many people also receive sedation to feel calm during surgery. In the United States, IV sedation is commonly used and requires close monitoring by an anesthesia team. In other countries, oral sedation is often used instead because it is simpler and less resource-intensive. The goal of this study is to see if oral sedation can provide the same level of safety, comfort, and recovery as IV sedation. Researchers are especially interested in how each type of sedation affects a person's thinking, memory, and overall recovery in the days after surgery. The study also looks at how satisfied participants are with their care, whether they experience side effects, and whether surgeons feel the surgery goes smoothly with each type of sedation. This is a small, pilot study that will enroll 20 adults aged 65 and older who are scheduled for cataract surgery. Participants will be randomly assigned by chance (like flipping a coin) to one of two groups: one group will receive a pill called alprazolam and a harmless IV placebo, while the other group will receive a placebo pill and standard IV sedation with a medication called midazolam. Everyone will still get numbing eye drops and be monitored by an anesthesia team during surgery for safety. Participants will complete simple memory and recovery tests before and after surgery, and follow-up phone calls will check on how they are feeling up to seven days after surgery. By closely monitoring thinking ability, comfort, and safety, this study aims to provide important information about whether oral sedation could be a good option for people undergoing cataract surgery in the United States. The results will help guide future research and inform doctors about the best ways to care for older adults during eye surgery.