Comparative Evaluation of Two Different Doses of Dexmedetomidine for Tympanoplasty under Monitored Anaesthesia Care

摘要

There are several advantages of performing tympanoplasty under Monitored Anaesthesia Care (MAC) and Dexmedetomidine is a good sedative-analgesic for MAC.Aim: To compare the analgesic and sedative efficacy of two different loading doses of dexmedetomidine for tympanoplasty under MAC.Materials and Methods: After taking ethical committee approval, patients were allocated into two groups of 40 each. Group I and Group II patients received injection dexmedetomidine at a loading dose of 1.0 μg/kg and 0.5 μg/kg respectively over 10 min followed immediately by a continuous infusion of 0.4μg/kg/h. Degree of sedation and pain intensity were assessed using Ramsay Sedation Score (RSS) and Visual Analogue Scale (VAS) respectively. Total rescue doses of Fentanyl and Midazolam as well as surgeon and patient satisfaction scores (Numerical Rating Scale NRS 0-10) were noted. Student t-test, paired t-test and chi-square test were used for statistical analysis.Results: Requirement of higher rescue doses of Fentanyl was more in Group II (100%) as compared to Group I (15.00%) (Z=61.760;p<0.001) and that of Midazolam was also more in Group II (92.50%) as compared to Group I (2.50%) (Z=65.234; p<0.001). Surgeon Satisfaction score was higher in Group I (8.75±0.54) than Group II (6.95±0.50) (Z=7.784;p<0.001). Patient Satisfaction score was also higher in Group I (8.70±0.56) than Group II (6.28±0.60) (Z=7.914;p<0.001).No postoperative complication was seen in any group.Conclusion: A loading dose of 1 μg/kg of dexmedetomidine over 10 min provides better sedation, analgesia, patient satisfaction and surgeon satisfaction than 0.5 μg/kg over 10 min without causing any per-operative problem and seems to be a safe and effective primary sedative technique for tympanoplasty under MAC.