Sedation for middle ear surgery: prospective clinical trial comparing propofol and midazolam

Abstract

<jats:title>Abstract</jats:title><jats:p>During middle-ear-surgery under local anaesthesia (MES-LA), patients report hearing noises, feeling anxious, and experiencing earache. In a prospective randomized clinical trial, we compared propofol and midazolam for sedation in 68 patients scheduled for MES-LA. The starting dose of propofol was 1 to 1.5 mg per kilogram intravenously, followed by 1 to 2 mg per kilogram per hour given by infusion. The starting dose of midazolam was 0.02 to 0.05 mg per kilogram intravenously, followed by 0.01 to 0.02 mg per kilogram intravenously. Metamizol and fentanyl were added when required. Sedation was titrated to a Ramsay score of 3 to 4 and a bispectral index value of 70 to 80. Patients were assessed for vital parameters and sedation and pain scores. In the recovery room, readiness for discharge and satisfaction of both patient and surgeon with the procedure were assessed. The group receiving propofol had a significantly lower heart rate, shorter duration of sedation, and earlier readiness for discharge (p&lt;0.05). There were no significant differences in other parameters evaluated. Seventy-nine per cent of patients in the group receiving propofol and 91.1% receiving midazolam would choose the same method of anaesthesia and sedation for any further MES-LA. Our results suggest that, compared to midazolam, propofol is more suitable for sedation in patients undergoing MES-LA. However, appropriate patient selection, adequate preparation, and careful monitoring are mandatory.</jats:p>

Comparison the Effects of Infusion of Propofol -Remifentanil with Midazolam-Remifentanil in Reducing Bleeding in Patients undergoing Middle Ear Surgery

“…Previous studies had compared the administration of Propofol and Midazolam in middle ear procedures. In his study Benedik J et al [8] reported that Propofol is more appropriate than Midazolam to make sedation in patients undergoing middle ear surgery, but in our study we recorded higher depth of anesthesia with Midazolam than Propofol, which was not statistically significant. In previous studies it has been shown that Propofol -Remifentanil is an appropriate method in ear surgery procedure because of its rapid recovery, creating intraoperative well condition and reducing post operation nausea and vomiting [1,2].…”

“…The procedures related to ear are very sensitive to stimulations particularly during the surgery, so creating a setting with minimal movements is inevitable which requires relatively deep anesthesia. Various sedative and hypnotic drugs have been used in numerous studies for middle ear surgery to facilitate the operation till now [1,2,[6][7][8][9]. In recent years, it has been shown that intravenous administration of Propofol in middle ear surgery has led to better condition during operation [1].…”

Patient satisfaction in middle ear surgery under monitored anaesthesia care

“…12 Similarly, Benedik et al compared propofol with midazolam infusion for sedation in middle ear surgeries which showed better sedation score with propofol. 13 However, we did not use any sedation score like Ramsay sedation score or Bispectral index monitoring to titrate the drug like in other studies. 9,12,13 We used mixture of injection 2% lignocaine with adrenaline 1:80000 and 0.5% bupivacaine 1:80000 in the volume of 12-16 ml.…”

“…13 However, we did not use any sedation score like Ramsay sedation score or Bispectral index monitoring to titrate the drug like in other studies. 9,12,13 We used mixture of injection 2% lignocaine with adrenaline 1:80000 and 0.5% bupivacaine 1:80000 in the volume of 12-16 ml. In some studies they have used injection lignocaine 2% with adrenaline 1:200,000.…”

“…and 86% of patients were willing to undergo similar procedure under local anaesthesia with sedation in future. 13,7…”