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A Comparative Evaluation of Dexmedetomidine and Midazolam in Monitored Anaesthesia Care for Tympanoplasty

Avani Tiwari, Post Graduate Trainee, Department of Anaesthesia, Gandhi Medical College, Bhopal Madhya Pradesh 462001, India. , Ruchi Tandon1 , Avani Tiwari2 , Rajni Thakur3

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Indian Journal of Anesthesia and Analgesia 5(3):p 456-459, March 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5318.17

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Abstract

Introduction: Monitored Anaesthesia care (MAC) has been defined by the American Society of Anaesthesiologists as a diagnostic or therapeutic procedure done under local anaesthesia along with sedation and analgesia. Advantages of performing tympanoplasty under MAC with local anaesthesia are less bleeding, improved post-operative analgesia, early and smooth recovery and discharge from hospital with least expenditure. The biggest advantage is intra-operative communication and assessment of hearing in the patient. Aim: The study was done to evaluate the efficacy of dexmedetomidine and midazolam for intra-operative sedation and analgesia in monitored anaesthesia care and to compare and assess any adverse effects in different groups of study. Methodology:The study was Conducted in the Department of Anaesthesiology, Gandhi Medical College and Hamidia Hospital, Bhopal on ASA Grade I and II patients scheduled for tympanoplasty. 90 patients of either sex of ASA Grade I and II, aged between 16 and 40 years were studied.All patient were premedicated with injection glycopyrolate 0.01mg/kg IV and Inj pentazocine 0.3 mg/kg over 1 min. Group A received Dexmedetomidine: Bolus dose 1mcg/kg IV followed by 0.4mcg/kg per hour, and Group B received Midazolam: Bolus dose of 0.04 mg given over 1 min. Oxygen supplementation through nasal catheter was given. Sedation was titrated to Ramsay Sedation score of 3. Rescue sedation with Midazolam 0.01mg/kg was given if RSS was <3 . Surgery was allowed to commence when Visual Analogue Scale (VAS) was <3. Sedation was assessed using Ramsay sedation Scale. Result and Conclusion: Sedation with Dexmedetomidine was found to be better alternative to midazolam in monitored anaesthesia care performed in minor ENT surgical procedures. It provides a calm sedated patient. Also, fall in the HR and MAP was seen in more number of patients of Group A than in Group B. This caused decreased bleeding, thus providing bloodless surgical field comfortable for the surgeon.

 

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5318.17

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Dexmedetomidine; Midazolam; Monitored Anaesthesia Care; Tympanoplasty. 

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