Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation

Abstract

Background:This study was conducted to compare the efficacy and effects of dexmedetomidine and midazolam in preoperative sedation.Materials and Methods:A total of 125 patients in American Society of Anaesthesiologists (ASA) I-II were divided into three groups: Group I (n = 40) for controls, Group II (n = 40) for Dexmedetomidine (1 μg/kg), and group III was the midazolam group (n = 45). Group III was further divided into three subgroups according to the doses of midazolam: Group IIIA (n = 15) received 0.02 mg/kg, group IIIB (n = 15) received 0.04 mg/kg, and group IIIC (n = 15) received 0.06 mg/kg of midazolam. Drugs were infused over a 10-minute period with appropriate monitoring. Ramsay and visual analog scores, for sedation and anxiety, respectively, and mean arterial pressure, heart rate, and SpO2 measurement, including respiratory rates were recorded, every 5 minutes for 30 minutes following infusion.Results:There was marked sedation and a decrease in anxiety in groups II and IIIC (P < 0.01). Mean arterial pressure (MAP) and heart rate (HR) decreased significantly in group II (P < 0.01 and P < 0.05, respectively), but there was no associated hypotension (MAP <60 mm Hg) or bradycardia (HR <50 bpm) (P < 0.05). Respiratory rates and SpO2 values decreased in groups II, IIIA, IIIB, and IIIC. The differences in respiratory rates were not significant (P > 0.05); however, decrease in SpO2 was significant in group IIIC (P < 0.01).Conclusions:Dexmedetomidine was as effective as higher doses of midazolam in sedation. The hemodynamic and respiratory effects were minimal. Although dexmedetomidine caused significant decrease in the blood pressure and heart rate, it probably just normalized increased levels caused by preoperative stress.

Comparison of Hypotension Caused By Dexmedetomidine– Fentanyl Combination with that of Midazolam–Fentanyl Combination in Hypertensive Patients Undergoing Tympanoplasty Surgery under MAC

“…These results are in accordance with those obtained in previous studies. [16,19,20,22,23] This proves that dexmedetomidine is a better sedative agent compared to that of midazolam and its duration of action is longer than that of midazolam. [18] In the present study, all patients were administered an antiemetic ondansetron before surgery to overcome the emetic effect of fentanyl.…”

“…This fall was more in group D compared to that of group M at all intervals in the study This may be due to increased hypotensive & sedative effect caused by dexmedetomidine compared to that of midazolam at all intervals. [21][22][23] In the present study, another reason for no evidence of severe oxygen desaturation & bradyapnea in any patient was the use of only single bolus dose of sedative drugs which were not followed by any maintenance doses. In the present study, the level of sedation was measured according to Ramsay Sedation Score1.…”

“…The dose of midazolam 0.06 mg/kg is comparable to that of dexmedetomidine 1µg/kg in term of sedation. [21][22][23] The doses of all three drugs were limited to a ceiling dose in the present study to prevent oversedation and respiratory depression. In spite of supplemental oxygen, mild fall in oxygen saturation was encountered in both groups during the first 15 min due to the peak sedative effect of drugs.…”

“…This technique is called Monitored Anaesthesia Care (MAC). [12] Medications commonly used for MAC include Ketamine, [13] Propofol, [14,15] Pentazocine, [16] combination of Midazolam-Fentanyl, [16][17][18][19][20] Midazolam as single agent, [21][22][23] Dexmedetomidine as a single agent and combination of Dexmedetomidine-Fentanyl. [20] Combination of Dexmedetomidine with Fentanyl leads to potentiation of all actions of Dexmedetomidine resulting in excellent hypotension, sedation and analgesia during the intraoperative period.…”

Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

“…Sedatif etkilerinin yanında, anksiyolitik, hipnotik ve analjezik etkilere de sahiptir. Santral sinir sisteminde, periferik sinirlerde ve otonom ganglionlarda a 2 reseptörlerini etkileyen deksmedetomidin, bu özellikleri nedeniyle yoğun bakım ünitelerinde sıklıkla tercih edilen bir ajan haline gelmiştir (11). Entübe olmayan hastalarda, cerrahi işlemlerde ya da diğer girişimlerde de sedasyon amacıyla kullanılmaya başlan-mıştır (12).…”