A comparative study of Dexmedetomidine versus midazolam with fentanyl for monitored anaesthesia care in tympanoplastyunder local anaesthesia
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 10, Issue 2
Abstract
Background and Aims: Monitored anaesthesia care (MAC) is a procedure in which the local anaesthesia(LA) and sedation provided using different drugs. We conducted this comparative study to see the safety and efficacy of Dexmedetomidine and midazolam with fentanyl for tympanoplasty under MAC. Methods: Fifty patients of age between 18 to 60 years of either sex posted for tympanoplasty under MAC were randomly allocated into two groups. Group D (n = 25) patient received intravenous (IV) dexmedetomidine 1 µg/ kg as bolus followed by an infusion 0.2 µg/kg/h. Group MF (n =25) patient received IV midazolam 0.05 mg / kg plus fentanyl 1.5µg/ kg as bolus followed by 0.2 ml/kg/h normal saline as an infusion. Sedation was titrated according to Ramsay Sedation score of 3. Rescue doses of midazolam 0.01mg/kg IV as sedation and fentanyl 1µg/ kg IV as analgesic was given when required, maximum 3 doses allowed.Patient’s oxygen saturation, hemodynamics, and need for intraoperative rescue sedation/analgesia were assessed as primary outcome. Surgeon satisfaction score were assessed as secondary outcome.The data were analyzed by Chi-square and unpaired t-test.Result: Number of rescue analgesia /sedation/infiltration/ was less in dexemeditomidine group (2/2/4) compared to group MF (14/14/20). Surgeon satisfaction score was higher in group D than group MF (P=0.001). Haemodynamically patients were stable in both the groups. Conclusion: Compared to midazolam with fentanyl, dexmedetomidine is a better alternative as it is associated with good haemodynamic control, without respiratory depression, lower pain scores and greater surgeon satisfaction.
Authors and Affiliations
Jigisha Badheka, Pratik M Doshi, Peram Shrividhya, Jaykishan Gol, Vandana Parmar
Keywords
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