A comparative randomized clinical trial to assess the efficacy between dexmedetomidine and midazolam infusions for procedural sedation during septoplasty

Abstract

Background: Septoplasty is often performed under sedation with local anesthesia. Midazolam is one of the commonly used sedative but it lacks analgesic effect. Dexmedetomidine is now preferred, owing to the side effects of midazolam. However, there seems to be addressable literature void in this regard. This study was aimed to evaluate and compare the effectiveness of sedation between midazolam and dexmedetomidine infusions for procedural sedation during septoplasty under local anesthesia Patients and Methods: This was a randomized clinical trial involving sixty patients undertaking elective septoplasty under local anesthesia randomized into Group A that received intravenous dexmedetomidine 1 μg/kg over 10 min, followed by continuous infusion 0.5 μg/kg/h and Group B receiving intravenous midazolam 50 μg/kg (over 10 min), followed by continuous infusion 50 μg/kg/h. The Ramsay sedation score (RSS) and patient and surgeon satisfaction scores were documented. The analysis was done using the Chi-square test and Student t-test. Results: A significant change in the heart rate from 10 to 60 min was observed between the two groups (P < 0.05). The midazolam group showed a significant increase in mean arterial pressure (MAP) from baseline to 40 min time interval (P < 0.05). The respiratory rate remained constant in both groups. Patients attaining target RSS of 3–4 were significantly higher in the dexmedetomidine group (P < 0.05). Patient satisfaction score and surgeon satisfaction score were higher in the dexmedetomidine group (P < 0.05). Conclusion: Dexmedetomidine for septoplasty under local anesthesia is more effective than midazolam infusion in providing adequate sedation and provides stable hemodynamics and well-preserved respiratory functions.