Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

Abstract

Özgün Araştırma / Original Article 195Objective: Hydatid cyst still continues to be a public health problem. The basic treatment for the disease is surgery, but USG-guided percutaneous drainage has become an important treatment alternative. Agents preferred for sedation during drainage performed under local anaesthesia must also preserve respiration and haemodynamic stability while providing adequate sedation. We used midazolam, which has a short duration of action, and a selective α 2 adrenergic receptor agonist, dexmedetomidine, and compared them regarding their sedative properties and intraoperative complications. Methods:After approval by the clinical trials ethics committee, 40 patients with similar demographic data were randomized into two groups. All patients received 10 mg metochlopramide and 45.5 mg phenyramine before the procedure. Then midazolam (0.07 mg kg -1 iv bolus followed by 0.01 mg kg -1 h -1 infusion) was administered to Group 1, and dexmedetomidine (1 µg kg -1 loading dose in 10 minutes, followed by 0.2 µg kg -1 h -1 continuous infusion) was administered to Group 2 for sedation. Just before the surgical procedure, all patients received propofol in a subhypnotic dose of 0.5 mg kg -1 iv. Propofol 0.5 mg kg -1 iv was administered to patients in each group if there was no adequate sedation. OAA/S and BIS scales were used to evaluate the sedation level during the procedure. HR, MAP, RR, SpO 2 and ETCO 2 values were monitored before and after induction and every 5 minutes thereafter. The propofol requirement was noted for each group.Results: Sedation in the dexmedetomidine group was as effective and adequate as that observed with the midazolam group. BIS values were significantly low in the dexmedetomidine group, especially after 10 minutes and thereafter. Respiratory rate, SpO 2 , and ETCO 2 values were similar in both groups, whereas clinically insignificant decreases in HR and MAP were observed in the dexmedetomidine group. Propofol requirements were similar in both groups. Conclusion:We conclude that dexmedetomidine can be an appropriate agent in surgical procedures performed under local anaesthesia, providing adequate sedation without respiratory depression.Key Words: Dexmedetomidine, midazolam, sedation Amaç: Kist hidatik hala önemli bir sağlık sorunu olmaya devam etmektedir. Temel tedavisinin cerrahi olması ile birlikte, günümüzde ultrasonografi eşliğinde yapılan perkütan drenaj da önemli bir tedavi alternatifi haline gelmiştir. Lokal anestezi altında yapılan bu işlem sırasında, sedasyon için tercih edilecek ajanlar, hastada yeterli sedasyonu sağlamanın yanı sıra solunumu ve hemodinamiyi en az düzeyde etkileyecek özellikte olmalıdır. Çalışmamızda kısa etkili bir benzodiazepin olan midazolamı ve α 2 selektif adrenerjik reseptör agonisti deksmedetomidini kullanarak, bu ajanları sedasyon derinliği ve intraoperatif komplikasyonlar açısından karşılaştırdık.Yöntemler: Etik kurul onayı ve hasta onamı alındıktan sonra demografik verileri benzer 40 hasta, randomize iki gruba ayrıldı. İşlem öncesi her...

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

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