Clinicians experienced with the newer anesthesia option of MKO Melt (Imprimis Pharmaceuticals, San Diego) say it has important advantages and some limitations. MKO Melt is a form of sublingual sedation for cataract and other surgery named for its medications—midazolam (3 mg), ketamine HCl (25 mg), and ondansetron (2 mg). Patients place it under their tongue prior to surgery and feel the effects within a couple of minutes. Full effect takes place around 10 minutes and lasts about 45 minutes to an hour, said Michael Greenwood, MD, Vance Thompson Vision, Fargo, North Dakota.

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