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Indian Journal of Anesthesia and Analgesia

Volume  5, Issue 3, March 2018, Pages 456-459
 

Original Article

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

Ruchi Tandon1, Avani Tiwari2, Rajni Thakur3

1Associate Professor 2Post Graduate Trainee 3Asst. Professor, Dep. of Anaesthesia, Gandhi Medical College, Bhopal Madhya Pradesh 462001, India.

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

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.

 

 


Keywords : Dexmedetomidine; Midazolam; Monitored Anaesthesia Care; Tympanoplasty. 
Corresponding Author : Avani Tiwari, Post Graduate Trainee, Department of Anaesthesia, Gandhi Medical College, Bhopal Madhya Pradesh 462001, India.