A Comparative Study of Dexmedetomidine Versus Midazolam-Pentazocine for Tympanoplasty Under Monitored Anaesthesia Care
Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 4
Abstract
Background: Monitored Anaesthesia Care (MAC)is a planned procedure during which the patient undergoes local anaesthesia with sedation and analgesia. MAC is chosen for 10-30% of all surgical procedures. Tympanoplasty is one of the procedure done under MAC. The present study was designed to compare newly introduced alpha-2 agonist drug, Dexmedetomidine with intravenous midazolam and pentazocine given routinely in our set up. Objectives: To compare intravenous dexmedetomidine with intravenous midazolam-pentazocine combination with respect to (i) Analgesic effect (ii) Sedation score (iii) Bloodless field during surgery (iv)Hemodynamic stability (v) Quality of anaesthesia. (vi) Postoperative analgesic requirement in 24 hours. Material and Methods: Sixty patients, ASA physical status I and II, posted for tympanoplasty under local anaesthesia with sedation were included in the study. The patients were randomly divided into two groupsGroup D: 30 patients received intravenous dexmedetomidine 1 mcg/kg over 10 min. followed by infusion 0.5 mcg/kg/hr till end of surgery. Group MP: 30 patients received intravenous midazolam 0.05mg/kg and intravenous pentazocine 0.5mg/kg followed by saline infusion at rate of 0.5ml/kg/hr. Vital parameters, sedation score (Ramsay Sedation score), Bleeding, requirement of rescue analgesic (IV Midazolam 0.01mg/kg and IV Ketamine 20 mg as and when required) and quality of anaesthesia noted. Results: The analgesic effect was better in Group D than Group MP. Only 1 patient in Group D required rescue analgesic whereas 17 patients in Group MP required rescue analgesic. There was fall in heart rate and fall in blood pressure in Group D. No such changes in hemodynamics seen in Group MP. Quality of anaesthesia was better in Group D than Group MP. The mean postoperative requirement of analgesic was 1.6 ± 0.49 in Group D and 2.86 ± 0.34 in Group MP. Conclusion: Intravenous Dexmedetomidine is an excellent drug for surgeries like Tympanoplasty done under monitored anaesthesia care. It not only improves intraoperative anaesthesia but also postoperative analgesia and thereby, improving the outcome of surgery.
Authors and Affiliations
Dr. Nazima Memon
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