Comparison of the sedative effects of midazolam and dexmedetomidine during regional anaesthesia

Öz

Objective: The aim of this study was to compare the effi­cacy of dexmedetomidine versus midazolam for sedation under spinal anesthesia for arthroscopic knee surgery. Materials and methods: Fifty adult patients, 18 to 65 years, were randomized into two groups: Group M re­ceived 0.04 mg/kg iv bolus midazolam followed by admin­istration of 0.5 mg boluses to provide Ramsay sedation Scale (RSS) 3-4. Group D received dexmedetomidine loading dose of 1 μg/kg/h over 10 minutes and the main­tenance dose of 0.2-0.7 μg/kg/h to achieve an adequate level of RSS 3-4. Recovery was evaluated with Modified Aldrete Scale. Pain was scored using Verbal rating scale (VRS). Postoperative VRS and Quality of Recovery (QoR) were recorded. Patients were asked to fill the question­naire that included 4 questions, and patient satisfaction was rated with VRS. Results: Heart rate and mean blood pressure values were found to be decreased in group D when compared with Group M (p

Anahtar Kelimeler

• Regional anesthesia, midazolam, dexme­detomidine, sedation.

Rejyonel anestezi sırasında midazolam ve deksmedetomidin\'in sedatif etkilerinin karşılaştırılması

Öz

Amaç: Bu çalışmada, spinal anestezi altında artroskopik diz cerrahisi uygulanacak olgulara sedasyon amacıyla deksmedetomidin ve midazolam uygulamasının etkilerini karsılaştırmayı amaçladık. Gereç ve yöntem: Yaşları 18-65 yıl arasında değişen 50 olgu randomizasyon ile iki gruba ayrıldı: Grup M\'deki ol­gulara midazolam 0.04 mg/kg intravenöz (iv) uygulandık­tan sonra Ramsay sedasyon skoru (RSS) 3-4 olacak şe­kilde 0,5 mg ek dozlarla işleme devam edildi. Grup D\'deki olgulara deksmedetomidin 1 μg kg/sa olacak şekilde 10 dakika yükleme dozu uygulandı. Takiben olguların RSS 3-4 olacak şekilde 0,2-0,7 μg/kg/sa deksmedetomidin in­füzyonuna başlandı. Operasyon süresince olguların vital bulguları kaydedildi. Olguların derlenmeleri modifiye Ald­rete skoru (MAS) ile belirlendi. Ağrı değerlendirmesinde sözel nümerik skala (VRS) kullanıldı. Postoperatif VRS ve derlenme kalite skorları (QoR) kaydedildi. Olgulardan 4 sorudan oluşan geri bildirim anketini doldurmaları istendi. Olgu memnuniyeti VRS ile değerlendirildi. Bulgular: Grup D\'de kalp hızları Grup M\'ye göre düşük bulundu (p

Anahtar Kelimeler

• Rejyonal anestezi, midazolam, deks­medetomidin, sedasyon.

Kaynakça

1. Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and anes- thesia. JAMA 1993; 270(12): 1437-41.
2. De Andres J, Valia JC, Gil A, Bolinches R. Predictors of patient satisfaction with regional anaesthesia. Reg Anesth 1995; 20(5): 498-505.
3. Wu CL, Naqibuddin M, Fleisher LA. Measurement of pa- tient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review. Reg Anesth Pain Med 2001; 26: 196-208.
4. Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient . BJA 2008; 100(1): 8-16.
5. Wilson KE, Girdler NM, Welbury RR. Randomized, con- trolled, cross-over clinical trial comparing intravenous mi- dazolam sedation with nitrous oxide sedation in children undergoing dental extractions. BJA 2003; 91(8): 850-6.
6. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95(4): 461-6.
7. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59(3): 263-8.
8. Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxolone. British Med J 1974; 12(7): 656-9.

9. P. Hu, D. Harmon, H. Frizelle. Patient comfort during re- gional anesthesia. J Clin Anesth 2007; 19(1): 67-74.
10. Standl T, Burmeister MA. Fast-track regional anesthesia. Curr Opin Anaesthesiol 2000; 13(6): 643-9.
11. Dahl V, Raeder J. Regional anaesthesia in ambulatory sur- gery. Curr Opin Anaesthesiol 2003; 16(5): 471-6.
12. Esener Z. Lokal/Bölgesel Anestezi Yöntemleri: Klinik Anestezi. 3. Baskı. Logos Yayıncılık, İstanbul 2004; 552- 88.
13. Macario A, Weinger M, Carney S, Kim A. Which clinical anaesthesia outcomes are important to avoid? The perspec- tive of patients. Anesth Analg 1999; 89(7): 652-8.
14. Ashish Sinha. Patient comfort during regional anesthesia: the obvious and the obscure. J Clin Anesth 2007; 19(1): 1-2.
15. Arıboğan A, Ünlügenç H, Reyhan E. Lokal anestezi sıra- sında “Bilinçli Sedasyon” uygulaması. TARDD 1999; 2(6): 537-44.
16. Olkkola KT, Ahonen J. Midazolam and other benzodiaz- epines. Handb Exp Pharmacol 2008;2(4): 335-60.
17. Aantaa RE, Kanto JH, Scheinin M, Kallio AM, Scheinin H. Dexmedetomidine premedication for minor gynecologic surgery. Anesth Analg 1990; 70(4): 407-13.
18. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomi- dine: a review of clinical applications. Cur Op Anesth 2008; 21(5): 457-61.
19. Venn RM, Karol MD, Grounds RM. Pharmacokinetics of Dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. BJA 2002; 88(7): 669-75.
20. Mantz J. Dexmedetomidine. Drugs Today 1999; 35(2): 151-7.
21. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intra- venous dexmedetomidine in humans. Anesthesiology 1992; 7(12): 1134-42.
22. Pandharipane P, Ely EW, Maze M. Dexmedetomidine for sedation and perioperative management of critically ill pa- tients. Semin Anesth Periop Med Pain 2006; 25(1): 43-50.
23. A Paris, P. H. Tonner. Dexmedetomidine in anaesthesia. Cur Opin Anaesthesiol 2005; 18(4): 412-8.
24. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazo- line receptors agonists. Anaesthesia 1999;54(2): 146-65.
25. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of in- travenous dexmedetomidine in humans. I. Sedation, ven- tilation, and metabolic rate. Anesthesiology 1992; 77(12): 1125-33.
26. Arain SR, Ebert TJ. The efficacy, side effects and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95(5): 461-6.
27. McCutcheon CA, Orme RM, Scott DA, Davies MJ, McGlade DP. A comparison of dexmedetomidine versus conventional therapy sor sedation and hemodynamic control during ca- rotid endarterectomy performed under regional anesthesia. Anesth Analg 2006; 102(6): 668-75.
28. Balcı C, Karabekir S, Kuru İ, Maralcan G, Taylan B. Monitörize anestezi bakımında propofol ve dekmedotomi- dinin hemodinamik ve bispektral indeks değerleri açısından karşılaştırılması. Anestezi Dergisi 2006; 14(2): 90-4.