Is dexmedetomidine better than propofol and fentanyl combination in minor day care procedures? A prospective randomised double-blind study

Abstract

Background and Aims:The growing popularity and trend of day care (ambulatory) anaesthesia has led to the development of newer and efficient drug regimen. We decided to evaluate the efficacy of two drug regimens namely dexmedetomidine and propofol with midazolam and fentanyl for moderate sedation characteristics in minor surgical procedures in terms of analgesia, intra-operative sedation, haemodynamic stability and side effects related.Methods:Totally, 60 adult American Society of Anaesthesiologists class I-II patients posted for day care surgeries of duration <45 min divided into two groups; Group D, where dexmedetomidine loading dose at 1 μg/kg was administered over 10 min followed by maintenance infusion initiated at 0.6 μg/kg/h and titrated to achieve desired clinical effect with dose ranging from 0.2 to 0.7 μg/kg, Group P, where midazolam at 0.02 mg/kg and fentanyl at 2 μg/kg IV boluses were given followed by propofol infusion. Statistical analysis was done using student t-test, analysis of variance and Chi-square analysis. P < 0.05 was considered to be significant.Results:Degree of sedation (Observer's Assessment of Activity and Sedation Scale ≤3) was comparable in both groups (P > 0.05). Rescue analgesia with fentanyl was needed in 30% patients of Group D compared to 17.63% patients of Group P (P < 0.05). The level of arousal was faster and better in Group D at 5 min after the procedure (P < 0.05). Haemodynamics were stable in Group D as with Group P patients (P < 0.005). Dry mouth reported by 16.67% patients.Conclusion:Dexmedetomidine can be a useful adjuvant rather than the sole sedative-analgesic agent during minor surgeries and be a valuable alternative to propofol in terms of moderate sedation, haemodynamic stability with minimal transient side effects.

Role of dexmedetomidine as an anaesthetic adjuvant in breast cancer surgery as a day-care procedure: A randomised controlled study

“…[ 6 ] It has been successfully employed as a total anaesthetic agent in minor surgical procedures and in day-care minimally invasive procedures and other minor procedures facilitating early discharge. [ 7 8 9 ] It has been seen to improve post-operative analgesia following radical mastectomy, but there is a paucity of literature regarding its influence on early discharge of patients undergoing breast cancer surgery. [ 10 ] Lower POP, decrease rate of nausea and vomiting and early mobilization are factors that foster such surgeries on daycare basis.…”

Effects of Various Anaesthetic Techniques on Haemodynamic Stability and Inflammatory Cytokine (IL-6) Level in Patients Undergoing Breast Cancer Surgery

“…21 During the intraoperative period, regional neuraxial blockade with general anaesthesia was significantly lower the mean arterial blood pressure (MAP) and pulse rate. 22 Tomar et al (2015) found that haemodynamic stability was significantly greater in dexmedetomidine along with fentanyl and PCM as compared to fentanyl and PCM group. 23 In the present study we observed that the IL-6 level was significantly different between pre and post-operative in group III whereas, it was not significantly different between group I and group II.…”

“…22 Tomar et al (2015) found that haemodynamic stability was significantly greater in dexmedetomidine along with fentanyl and PCM as compared to fentanyl and PCM group. 23 In the present study we observed that the IL-6 level was significantly different between pre and post-operative in group III whereas, it was not significantly different between group I and group II. Similary, Li et al (2014) reported that the perioperative use of dexmedetomidine as an adjunct substantially decreases serum IL-6 levels.…”

Perbandingan Kedalaman Sedasi antara Deksmedetomidin dan Kombinasi Fentanil-Propofol Menggunakan Bispectral Index Score pada Pasien yang Dilakukan Kuretase

“…Keterbatasan penggunaan BIS, yaitu tidak dapat memprediksi respons terhadap rangsangan nyeri dan penambahan opioid. 5,14 Penelitian ini didapatkan nilai BIS sebelum tindakan kuretase ( Tabel 2) 8,9,15 Hasil penelitian ini juga memperlihatkan perbedaan hasil pada MAP, laju nadi, dan saturasi oksigen pada kedua kelompok. Nilai MAP pada kedua kelompok terjadi penurunan dari data dasar, kelompok FP lebih rendah dibanding dengan kelompok D (Gambar 1), tetapi tidak berbeda bermakna secara klinis seperti hipertensi atau hipotensi pada pasien.…”

“…Penurunan MAP pada kelompok FP disebabkan oleh penurunan tahanan sistemik vaskular, kontraktilitas jantung, dan aliran darah balik. 7,8,14 Hasil penelitian ini menunjukkan laju nadi (Gambar 2) pada kelompok deksmedetomidin lebih rendah dibanding kelompok fentanilpropofol, tetapi tidak berbeda bermakna secara klinis seperti bradikardia yang membutuhkan terapi tambahan pada pasien. 8,10,11 Penelitian ini sesuai dengan penelitian yang membandingkan deksmedetomidin dengan fentanil-propofol pada pasien yang dilakukan tindakan dilatasi dan kuretase dengan hasil pada kelompok deksmedetomidin itu terjadi perlambatan laju nadi, tidak terjadi desaturasi, dan juga MAP hampir sama dibanding dengan fentanil-propofol.…”