To Compare the Safety and Efficacy of Conscious Sedation with Dexmedetomidine and Propofol Infusion for Endoscopic Discectomy.

Abstract

Endoscopic discectomy is a minimally invasive, day care spine surgery. Patient comfort is of utmost importance as it is performed under local anaesthesia and in prone position. Propofol and dexmedetomidine are titrable and short-acting and commonly used for conscious sedation. The objectives of the study are to study the effect of dexmedetomidine and propofol infusion on cardiorespiratory parameters and to evaluate the efficacy of dexmedetomidine and propofol infusion for conscious sedation. This is a prospective, randomized, patient-blinded study. Sixty adult patients were randomly recruited to 2 groups of 30 each, to receive an infusion of dexmedetomidine or propofol, titrated to bispectral index score 70-80. The intra-operative cardiorespiratory parameters and level of sedation, postoperative visual analogue scale score, time to discharge from post-anaesthesia care unit, and patient satisfaction were monitored. Both groups were comparable with respect to demographic parameters and surgical duration. The heart rate was significantly lower with dexmedetomidine whereas the intraoperative mean arterial pressure was higher with dexmedetomidine. Though the level of intraoperative sedation was higher with propofol, the respiratory parameters were comparable. Postoperative visual analogue scale score was significantly higher with propofol. Dexmedetomidine and propofol provide adequate sedation without any cardiorespiratory compromise when used for conscious sedation for minimally invasive spine surgeries performed in prone position. Dexmedetomidine provides an added advantage of postoperative analgesia and better patient satisfaction.