A study to compare the overall effectiveness between midazolam and dexmedetomidine during monitored anesthesia care: A randomized prospective study

Abstract

Background:Monitored anesthesia care (MAC) combines intravenous sedation along with local anesthetic infiltration or nerve block. Several drugs have been used for MAC, but all are associated with complications. Dexmedetomidine is a selective α2-adrenoceptor agonist with both sedative and analgesic properties and is devoid of respiratory depressant effects. Its short elimination half-life makes it an attractive agent for sedation during MAC.Aim:Comparative evaluation of dexmedetomidine and midazolam for MAC.Methods:In this prospective, randomized, double-blind study, 50 American Society of Anesthesiologist I and II patients undergoing a surgical or diagnostic procedure of <1 h requiring MAC were enrolled. Dexmedetomidine-ketamine (Group “KD”) patients (n = 25) received intravenous (I.V.) dexmedetomidine 1 mcg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine. Midazolam-ketamine patients (n = 25) received I.V. midazolam 0.05 mg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine to get a targeted level of sedation (≤4 using Observer's Assessment of Alertness/Sedation Scale score). Inadequate sedation (e.g., 15% increase in mean arterial blood pressure or heart rate, decrease in degree of calmness, increase in respiratory rate, physical movement) was treated by a ketamine bolus of 0.5 mg/kg as a rescue analgesia.Statistical Analysis:The statistical tests used in the study are unpaired Student's t-test for continuous variables and Chi-square test for categorical variables. Mann–Whitney test was used to assess the patient and surgeon satisfaction. Data were expressed as mean ± standard deviation. Value of P < 0.05 is considered significant and P < 0.0001 as highly significant.Results:Clinically desired sedation and analgesia was achieved earlier and better with dexmedetomidine. Patients and surgeons satisfaction were significantly higher with dexmedetomidine. The requirement of additional sedation and analgesia was less in dexmedetomidine (KD) group.Conclusion:During MAC dexmedetomidine provides better sedation and analgesia than midazolam.

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

“…Most of the studies reported a statistically significant higher physician satisfaction with DEX (n = 15; 42.8%), when compared to the control group, 61 , 65 , 30 , 71 , 36 , 98 , 43 , 52 , 63 , 73 , 58 , 18 , 97 , 37 , 94 or did not report any statistically significant difference between both groups (n = 15; 42.8%). 23 , 81 , 69 , 38 , 44 , 56 , 104 , 54 , 35 , 53 , 29 , 72 , 39 , 75 , 47 A few studies (n = 6; 10.9%) reported a statistically significant higher physician satisfaction in favor of the control group.…”

“… Nooh 15 Saudi Arabia (20–28) 56 18 1 Surgical removal of the third molar NIBP, ECG, pulse oximeter, modified OAA/S score and BIS 1: 1.5 μg.kg −1 intranasal atomized DEX 2: intranasal water 30 min before the procedure No clear definition Preoperative anxiety, reaction to the anesthetic injection, pain, sedation score, vital signs, adverse events and complications and total analgesic consumption. Dental procedure (n = 19) Rasheed 30 India (20–50) 46 50 1, 2 Not specified NIBP, ECG, pulse oximeter and OAA/S score 1: 1 μg.kg −1 iv DEX for 2 min + 0.5 mg.kg −1 iv ketamine 2: 0.05 mg.kg −1 iv MDZ for 2 min + 0.5 mg.kg −1 iv ketamine NR No clear definition Duration of procedure, induction-incision time, hemodynamic effects, duration of analgesia, mean a total extra dose of ketamine and patient and physician satisfaction. Salazar 31 Venezuela (18–30) 38.6 44 1, 2 Surgical removal of the third molar RR, SBP, DBP, MAP, SpO 2 , ECG, HR and RSS 1: 0.2 μg.kg −1 .h −1 iv infusion DEX 2: 0.1 mg.kg −1 .min −1 iv infusion propofol Before and during the procedure Patient behavior (pain or discomfort) during the procedure Sedation score, time until sedation, patient response, hemodynamic and respiratory effects, need for additional anesthetic, recovery time, need for rescue Alfentanil and adverse events and complications.…”

“…The studies included were from 2004 onward, 21 from before 2013 and 75 from 2013 onward. Twenty-three studies were conducted in India, 16 , 17 , 86 , 48 , 51 , 20 , 90 , 28 , 61 , 64 , 65 , 66 , 30 , 21 , 106 , 107 , 84 , 71 , 108 , 32 , 82 , 78 , 68 sixteen in China, 41 , 87 , 88 , 59 , 23 , 24 , 25 , 89 , 81 , 36 , 109 , 69 , 110 , 111 , 95 , 103 thirteen in Turkey, 38 , 96 , 98 , 40 , 43 , 44 , 19 , 99 , 52 , 55 , 56 , 104 , 22 nine in Japan, 49 , 27 , 54 , 63 , 77 , 67 , …”

“…Twenty-five trials were judged to be low risk of bias in all domains. 86 , 90 , 64 , 66 , 107 , 78 , 68 , 41 , 87 , 23 , 24 , 25 , 81 , 36 , 69 , 103 , 58 , 92 , 105 , 29 , 85 , 37 , 62 , 47 , 93 Forty trials had unclear risk of bias, 15 , 16 , 51 , 20 , 28 , 30 , 21 , 106 , 84 , 108 , 32 , 82 , 89 , 109 , 110 , 95 , 96 , 40 , 19 , 52 , 56 , 22 , 49 , 27 , 54 , 72 , 39 , 83 , 70 , 60 , 45 , 50 , 79 , 102 …”

Comparison of Dexmedetomidine with Midazolam during Monitored Care Anesthesia (MAC) in Patients Undergoing Septoplasty

“…20 Another study reported that sedation with dexmedetomidine for MAC is associated with lower rescue doses of sedatives and analgesics as well as it is associated with higher surgeons and patient satisfaction score as compared to midazolam. 21 Parikh and colleagues compared the effects of dexmedetomidine to the standard midazolam-fentanyl combination in patients undergoing tympanoplasty surgery under MAC. It boosted patient and surgeon satisfaction, indicating a better sedative profile; however, it decreased heart rate and blood pressure, needing regular monitoring.…”