Indian Journal of Clinical Anaesthesia

Comparative Evaluation of IV Dexmedetomidine versus Dexmedetomidine with Butorphanol as an Adjuvant for Monitored Anaesthesia Care in Tympanoplasty and Myringoplasty: A Prospective, Controlled, Ran

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Author Details: Alka Kewalramani(Chhabra), S. S. Jaitawat, Sunanda Gupta, Shashank Gupta

Volume : 3

Issue : 1

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 96

Article End Page : 101


Background and Aims: It is a common practice to perform procedures like Tympanoplasty and Myringoplasty under Monitored Anaesthesia care (MAC). The recently introduced selective α2 agonist dexmedetomidine, known for its opioid sparing effect along with sedative, analgesic  hypotensive and anaesthetic properties with minimal respiratory depression has been used as a sole agent to provide MAC in various surgical interventions. The present study is aimed to evaluate the role of Dexmedetomidine as a sole sedoanalgesic agent and compare the efficacy of adding an adjuvant like Butorphanol to Dexmedetomidine.
Material & Methods: 60 patients of either sex, aged 18-20 years, ASA grade I&II  were randomized into two groups(D and BD) of 30 patients each for microscopic ear surgery under Local Anaesthesia(LA) with MAC. Group D received inj. Dexmedetomidine 1 mcg/kg iv loading dose while Group BD received inj. Dexmedetomidine 1 mcg/kg iv loading dose along with inj. Butorphanol 0.02 mg/kg. Both groups received an infusion of inj. Dexemetomidine @ 0.2 mcg/kg/hr. All patients were assessed for intraoperative haemodynamic changes, SpO2, respiratory rate, Ramsay sedation score(RSS), and visual analogue scale(VAS).Rescue doses of sedatives, analgesics, satisfaction scores(Patients and Surgeons) were compared in both the groups. Data was analyzed using chi-square and t-test.  p value <0.05 was considered significant.
Results: Mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were significantly decreased from baseline in group BD as compared to group D (p<0.001). RSS, in group BD was significantly higher as compared to group D throughout the surgery. Rescue sedation was given in 3 patients in group BD while in group D, 9 patients required additional sedation (p<0.01) .Rescue analgesic with iv fentanyl was administered in 27 patients and 6 patients respectively in groups D and BD.Patient and surgeon satisfaction scores were also  significantly higher in group BD vs group D (p<0.001).
Conclusion: A combination of Dexmedetomidine with Butorphanol as an adjuvant for Monitored Anaesthesia Care in microscopic ear surgery was found to provide superior sedoanalgesia.

Key Words:
Monitored Anaesthesia Care, Dexmedetomidine, Butorphanol, Middle ear surgery