MONITORED ANAESTHESIA CARE: COMPARISON OF PROPOFOL-NALBUPHINE, PROPOFOL-FENTANYL AND PROPOFOL-DEXMEDETOMIDINE IN MIDDLE EAR SURGERY: A DOUBLE BLIND RANDOMIZED TRIAL

Abstract

Subject and Methods:  90 patients, who belongs to American society of Anesthesiologist grade I & II of age 18-65 years randomized into three groups (n=30). All three groups received propofol bolus 0.75mg/kg IV followed by IV infusion at 0.025 mg/kg/min. group A received Nalbuphine 50 ?g/kg IV bolus, group B fentanyl 1.5 ?g/kg IV bolus and group C received Dexmedetomidine infusion 1 ?g/kg given over 10 min as bolus followed by 0.1 mg/kg/hr IV infusion for maintenance. Ramsay sedation score and Visual analogue scale measured for sedation and analgesia respectively at 10 minute interval for 1st hour of surgery then every 30 minutes upto the end of surgery. Desired RSS was defined 3-5. Intraoperative hemodynamic variables viz. Heart Rate (HR), Respiratory Rate (RR), Mean Arterial Pressure (MAP) and SPO2 were recorded every 10 min till the end of surgery. Recovery was assessed using Modified Aldrete Score in the recovery room. Time to achieve Aldrete recovery score of 10 was recorded. Patient satisfaction score and Surgeon satisfaction score were noted using a 7-point Likert verbal rating scale.

Results: The groups were comparable with respect to demographic parameters. Ramsay sedation was significantly higher in Dexmedetomidine group (P<0.05) than Nalbuphine and fentalyl group, while Visual analogue score was comparable in all three study groups (p>0.05). Heart rate and Mean arterial pressure both significantly decreased in Dexmedetomidine group from the baseline during study period (p<0.05). Respiratory rate and SPO2 were comparable in all three groups. In this study MAP was never <60 mmhg, SPO2 was never <94% and Respiratory rate was never <12 bpm. Time to achieve modified alderate score in Dexmedetomidine (0.93±2.33 min) was significantly least as compare to Nalbuphine (1.80±2.65) & Fentanyl group (3.50±4.76) (p=0.016). Patient satisfaction score in Dexmedetomidine was significantly higher (6.53±0.44) (p=0.005). Surgeon satisfaction score in Dexmedetomidine was also significantly higher (6.73±0.52) (p=0.000). Two patients in Dexmedetomidine group had episode of bradycardia which was managed with injection Atropine 0.6 mg effectively Conclusion: From these observations and analyses of the present study, it can be inferred that:

? Sedation in Dexmedetomidine was acceptable when used for MAC for middle ear surgeries.

? Visual analogue score was similar in all three study groups.

? Heart rate & Mean arterial pressure in Dexmedetomidine was lower than baseline value.

? Changes in Respiratory rate and SPO2 were similar in all three study groups.

? Time to achieve Modified alderate score of 10 in group Dexmedetomidine was least, suggesting quicker recovery from anesthesia.

? Patient and surgeon satisfaction score in Dexmedetomidine was significantly higher.

Keywords: Dexmedetomidine, Nalbuphine, Bupivacaine, Ropivacaine