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A Study of Dexmedetomidine Compared with Midazolam for Sedation in Endoscopic Dacryocystorhinostomy
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Purpose: The objective of this study were to study the efficacy of dexmedetomidine as a sedative for endoscopic dacryocystorhinostomy performed under local anaesthesia compared to conventional sedative like midazolam and also to study the effects of dexmedetomidine on hemodynamic stability and analgesia.
Methods: In this randomized,prospective double-blinded study 40 adult patients were allocated into two groups.Group D received dexmedetomidine 1μg/kg loading dose over 10 minutes followed by 0.5 μg/kg/hr maintenance dose and Group M received 20 μg/kg midazolam at the start of procedure plus same dose repeated 30 minutes later. Endoscopic dacryocystorhinostomy was performed in all patients under local anesthesia. Sedation was assessed using the modified Observer's Assessment Alertness/ Sedation (OAA/S) scale. Pulse rate(PR), Mean arterial pressure(MAP),oxygen saturation (SpO 2), respiratory rate (RR) were recorded every 5 minutes for first fifteen minute and then every ten minutes till the end of the procedure.In the post anaesthesia care unit,Aldrete score was determined every 5 minutes till the patient was ready for discharge.
Results: Pateints receiving dexmedetomidine had a better OAA/S score throughout the procedure and were more cooperative. VAS scores were significantly lower in the dexmedetomidine group.Pulse rate, MAP were lower in Group D whereas SpO 2 values were higher in Group D compared to Group M. Group D had lesser amount of bleeding but the time taken to reach an Aldrete score of 10 was similar between the groups.
Conclusion: Dexmedetomidine is ideal for procedural sedation with the added benefit of hemodynamic stability, no respiratory depression and analgesia.
Keywords
- Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, & Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 2005;112:1463-1468
- Ranga RK, Yadav SP, Advin. Endo-DCR: is it an end of the road for external DCR?. J Indian Med Assoc. 2008 Apr;106:228, 230-1
- Howden J, McCluskey P, O’Sullivan G, Ghabrial R. Assisted local anaesthesia for endoscopic dacryocystorhinostomy. Clin Experiment Ophthalmol. 2007 Apr; 35: 256-61.
- Smith I, Avramov MN, White PF. A comparison of propofol and remifentanil during monitored anesthesia care. Journal of Clinical Anesthesia. 1997 Mar;9:148-154.
- Nieuwenhuijs D, Sarton E, Teppema L, Dahan A. Propofol for Monitored Anesthesia Care: Implications on Hypoxic Control of Cardiorespiratory Responses. Anesthesiology. 2000 Jan;92:46
- Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A review of clinical applications. Curr Opin Anaesthesiol 2008;21:457-61
- Nelson LE, You T, Maze M, Franks NP. Evidence that the mechanism of hypnotic action in dexmedetomidine and muscimol-induced anesthesia converges on the endogenous sleep pathway. Anesthesiology 2001;95:A1368
- Keith A, Sergio D, Paula M, Marc A, Wisemandle W, Alex Y. Monitored anesthesia care with dexmedetomidine:A prospective, randomized, double-blind, multicerter trial. Anesth Analg 2010;110:47-56
- Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000 Mar;90:699-705
- Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The Correlation Between Bispectral Index and Observational Sedation Scale in Volunteers Sedated with Dexmedetomidine and Propofol. Anesth Analg 2009 Dec;109:1811-1815
- Carlsson AM, Karolinska S. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87-101
- Jacobi KE, Bohm BE, Rickauer AJ, Jacobi C, Hemmerling TM. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 2000;12:202-207.
- Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg1970;49:924-34
- Alhashemi J A.Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth 2006; 96:722-6
- Ustün Y, Gündüz M, Erdoðan O, Benlidayi ME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg. 2006 Sep;64:1353-8.
- Bergese SD, Candiotti KA, Bokesch PM, Zura A, Wisemandle W, Bekker AY. A Phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation. Am J Ther. 2010 Nov- Dec;17:586-95.
- Shahbaz R. Arain, MD. The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery. AnestH Analg 2004 Jan; 1:153-158
- Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008 Jan;25:22-8.
- Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored anesthesia care with dexmedetomidine: A prospective, randomized, double blind, multi center trail. Anesth Analg 2010;110:47-56.
- Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol. 2011 Sep;120:586-92.
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