A comparative study of dexmedetomidine vs midazolam for sedation and hemodynamic changes during tympanoplasty and modified radical mastoidectomy

Abstract

Background: The benzodiazepine, Midazolam, has been used medication given for sedation in tympanoplasty and mastoidectomy because of a number of beneficial effects. However, Dexmedetomidine is a highly selective α2-adrenoceptor agonist is emerging as preferred choice now a day. The aim of the study is to compare hemodynamic stability and sedation under Dexmedetomidine vs Midazolam during tympanoplasty and modified radical mastoidectomy done under local anaesthesia. Methods: After obtaining ethics clearance from institution and written informed consent from patients, 50 patients of age group 15 to 50 years of ASA grade i & ii were selected and divided in to two groups: Group D: Inj. Dexmedetomidine 1µg/kg over 15min, followed by 0.5µg/kg/hr (n= 25). Group M: Inj. Midazolam 0.05 mg/kg i.v. slowly, followed by 0.01mg/kg/hr (n= 25). Arterial blood pressure, heart rate and sedation level were monitored. The surgeons and patients were asked to rate their satisfaction, using the Likert scale. Results: Sedation score difference between group Dand group M was not statistically significant. There was no statistically significant difference found in diastolic blood pressure of both the groups. There was a significant reduction in heart rate in group D as compared to group M. Surgeon’s satisfaction score and patient’s satisfaction score both were high in group D compare to group M. Conclusions: For monitored anaesthesia care in ENT surgeries performed under local anaesthesia, inj. Dexmedetomidine could be a better alternative over inj. Midazolam. [Int J Basic Clin Pharmacol 2013; 2(5.000): 562-566

Comparative study of dexmedetomidine versus midazolam in monitored anaesthesia care in tympanoplasty surgery

“…Fentanyl IV intraoperatively and Inj. Diclofenac IV postoperatively) which is concordance with previous studies [12,[16][17][18] suggesting analgesic effect of dexmedetomidine was better than midazolam in perioperative period in patients undergoing surgery with LA and MAC. When compared with midazolam, dexmedetomidineinduced bradycardia was not statistically significant and was not found to be clinically challenging.…”

“…These results are correlated well with the earlier studies [22,23] . Parikh et al [4] and Vyas [5] and demonstrated significant higher surgeon's satisfaction score in group D than in group M in their studies. But in present study, the surgeon satisfaction score of 4-5 was achieved among 80.0% of surgeons in both the groups.…”

“…Midazolam is a potent imidazobenzodiazepine which possesses typical benzodiazepine properties namely hypnotic, amnestic, anticonvulsant and anxiolytic activity. Midazolam is the most frequently used sedative and has been reported to be well tolerated when used in MAC [5] . However, it has a number of beneficial effects when used for sedation, fast onset, and limited duration of action.…”

Merits and demerits of transcanal tympanoplasty: an observational study

“…Sedation and analgesia here are achieved with either midazolam or dexmedetomidine in modern day-care surgeries. Dexmedetomidine is a new drug which acts on α2-adrenergic receptors in the dorsal horn of the spinal cord to produce adequate analgesia and It has been reported to significantly reduce the opioid requirements both during and after surgery, according to Verma et al 12 Compared with midazolam, it gives better haemodynamic stability and patient satisfaction according to a study by Vyas et al 13 Various published studies suggest that dexmedetomidine provides adequate sedation with analgesia and good surgical and patient comfort without any adverse effects for patients undergoing tympanoplasty under local anaesthesia. The amount of blood loss during surgery, which also amounts to a better oligaemic field, especially in middle ear surgery was also significantly lesser with this drug in a study by Gupta et al 14 Propofol usually used in the induction of GA is associated with the increased requirement of post-operative rescue analgesic and increased intraoperative hemodynamic instability (hypotension).…”