The comparison of sedation quality of dexmedetomidine with midazolam using bispectral index and Ramsay sedation score in tympanoplasty under monitored anesthesia care

Abstract

Background and aims Tympanoplasty is most commonly performed under local anesthesia supplemented with sedation. Midazolam is a commonly used drug in such procedures. Recently, dexmedetomidine is used for procedural sedation. We carried out a study to find whether dexmedetomidine is superior to midazolam in monitored anesthesia care in terms of sedation quality using bispectral index (BIS) and Ramsay sedation scale (RSS). Patients and methods This randomized, prospective, single-blind study included 56 patients aged 18–50 years, equally divided into two groups. In group 1 (n=28), inj. dexmedetomidine 1 µg/kg over 10 min followed by infusion of 0.5 µg/kg/h was given. In group 2 (n=28), inj. midazolam 0.02 mg/kg intravenous followed by infusion of 0.01 mg/kg/h was given. Local anesthesia (2% lignocaine with adrenaline 1 : 200 000) was given by surgeon at the incision site. Inj. tramadol is used as rescue analgesia. Both groups were compared using BIS, RSS, hemodynamic parameters at regular time interval during surgery, and number of times rescue analgesia was required during surgery. Results There is a significant decrease in heart rate after giving bolus dose in dexmedetomidine group. There was a significant difference of RSS in both groups at the time interval at RSS 4, RSS 5, and at RSS 6. There was a significant difference of BIS score in both groups at the time interval of BIS 4, BIS 5, and BIS 6. There was one patient who needed rescue tramadol in group 1, whereas in group 2, two patients needed rescue tramadol. Conclusion We concluded that for monitored anesthesia care in surgeries like tympanoplasty performed under local anesthesia, inj. dexmedetomidine can be a better alternative over inj. midazolam with respect to sedation quality and fewer requirements of rescue analgesia. However, dexmedetomidine has an adverse event, that is, bradycardia, which can be manageable.