A prospective randomized double blind study to compare dexmedetomidine and midazolam in ear nose and throat surgery for monitored anesthesia care

Authors

  • Manmath A. Delmade Department of Anaesthesiology, LTMMC & LTMGH, Sulochana Shetty Road, Sion, Mumbai-22
  • Devangi A. Parikh Department of Anaesthesiology, LTMMC & LTMGH, Sulochana Shetty Road, Sion, Mumbai-22

DOI:

https://doi.org/10.18203/2320-6012.ijrms20162228

Keywords:

Dexmedetomidine, Midazolam, Sedation, Monitored anaesthesia care, Otorhinolaryngology, Surgery

Abstract

Background: Analgesia and sedation are usually required for the comfort of the patient during ear, nose and throat surgery done under local anesthesia as a part of monitored anesthesia care (MAC). In this study, patients satisfaction scores and effectiveness of sedation and analgesia with dexmedetomidine were compared with midazolam.

Methods: Thirty patients received intravenous dexmedetomidine 1µg/kg bolus for 10 minutes followed by continuous infusion at 0.5 µg/kg/hr (group D). Thirty patients received intravenous midazolam 40 µg/kg bolus for 10 minutes followed by infusion at 50 µg/kg/hr (group M). Intravenous fentanyl (2ug/kg) was administered in both the groups. Vital parameters such as heart rate, mean blood pressure (MBP), respiratory rate (RR), SpO2, ramsay sedation score (RSS) and visual analog scale (VAS) was observed and recorded throughout the operation and then three times in the recovery room i.e. at arrival 30 and 60 min. After achieving RSS = 3, local infiltration at surgical site was given.

Results: The drop in HR and MBP from pre-operative value was observed at various intervals during the surgery and also in the recovery in both the groups but it was significant in group D (P<0.005). Patient satisfaction was significantly better with dexmedetomidine compared to midazolam (p=0.0001). There were no side effects in both of the groups except for bradycardia in group D which was reversed easily with injection atropine.

Conclusions: Dexmedetomidine promises to be a suitable alternative to midazolam with added advantage of better patient satisfaction and faster recovery, but with close monitoring of hemodynamics.

References

Sa Rego MM, Watcha MF, White PF. The Changing Role of Monitored Anesthesia Care in Ambulatory Setting. Anesth Analg. 1997;85:1020-36.

Miller RD, Miller’s Anesthesia, Churchill Livingstone Elsevier. 7th edn. 2009, volume 2, Chapter 78 Ambulatory (Outpatient) Anesthesia, p. 2437-9.

Stahle H, Bindra JS, Lednicer D, Ed. Chronicles of drug discovery, vol. 1. New York: John Wiley and Sons. 1982;87-111.

Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263-8.

Kamibayashi T, Maze M. Clinical uses of α2adrenergic agonists. Anesthesiology. 2000;93;1345-9.

Philipp M, Hein L. Adrenergic receptor knockout mice: distinct functions of 9 receptor subtypes. Pharmacol Ther. 2004;101:65-74.

Berkenbosch JW, Wankum PC, Tobias PC, Joseph D. Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatr Crit Care Med. 2005;6:435-9.

Koroglu A , Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO. Sedative, hemodynamic and respiratory effects of dexmeditomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth. 2005;94:821-4.

Alhashemi JA. Dexmedetomidine vs midazolam for monitored anesthesia care during cataract surgery. Br J Anaesth. 2006;96:722-6.

Karaaslan K, Yilmaz F, Gulcu N, Colak C, Sereflican M, Kocoglu H. Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study. Curr Ther Res Clin Exp. 2007;68:69-81.

Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, Akcan Y. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol. 2007;21:25-9.

Ustün Y, Gündüz M, Erdogan O, Bendlidayi ME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg. 2006;64:1353-8.

Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA,Domino KB. Injury and liability associated with monitoredanesthesia care: A closed claims analysis. Anesthesiology. 2006;104:228-34.

Smith H, Elliott J. Alpha (2) receptors and agonists in pain management. Curr Opin Anaesthesiol. 2001;14:513-8.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuatessympathetoadrenal response to tracheal intubation and reducesperioperative anaesthetic requirement. Indian J Anaesth. 2011;55:352-7.

Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored anesthesia care with dexmedetomidine:A prospective, randomized, double‑ blind, multicenter trial. Anesth Analg 2010;110:47-56.

NaH S, Song IA, Park HS, HwangJW, Do SH, Kim CS. Dexmedetomidineis effective for monitored anesthesia care in outpatients undergoing cataract surgery. Korean J Anesthesiol. 2011;61:453-9.

Zeyneloglu P, Pirat A, Candan S, Kuyumcu S, Tekin I, Arslan G. Dexmedetomidine causes prolonged recovery when compared with Midazolam/fentanyl combination in outpatient shock wave lithotripsy. Eur J Anaesthesiol. 2008;25:961-7.

Downloads

Published

2017-01-04

How to Cite

Delmade, M. A., & Parikh, D. A. (2017). A prospective randomized double blind study to compare dexmedetomidine and midazolam in ear nose and throat surgery for monitored anesthesia care. International Journal of Research in Medical Sciences, 4(8), 3159–3163. https://doi.org/10.18203/2320-6012.ijrms20162228

Issue

Section

Original Research Articles