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ORIGINAL ARTICLE
Year : 2016  |  Volume : 60  |  Issue : 2  |  Page : 89-93

Comparative evaluation of two different loading doses of dexmedetomidine with midazolam-fentanyl for sedation in vitreoretinal surgery under peribulbar anaesthesia


Department of Anaesthesia, Nethradhama Super Speciality Eye Hospital, Jayanagar, Bengaluru, Karnataka, India

Correspondence Address:
Suman Shree Ramaswamy
Department of Anaesthesia, Nethradhama Super Speciality Eye Hospital, No. 256/14, Kanakapura Main Road, 7th Block, Jayanagar, Bengaluru - 560 070, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.176277

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Background and Aims: Midazolam-fentanyl (MDZ:FEN) combination has been routinely used for intravenous sedation in ophthalmic surgeries. Dexmedetomidine (DEX), a recent α2 adrenoreceptor agonist indicated for sedation for ophthalmic use at a loading dose of 0.5 μg/kg over 10 min, can cause deeper plane of sedation and surgeon dissatisfaction. Therefore, we proposed to evaluate the efficacy and safety of two different loading doses of DEX. Methods: In a prospective study, 60 patients aged 50-70 years, scheduled for retinal surgery under peribulbar block were divided equally to receive either MDZ:FEN or DEX 0.5 μg/kg (DEX full) or DEX 0.25 μg/kg (DEX half) loading dose over 10 min followed by titrated maintenance dose of DEX 0.25-0.4 μg/kg/h. Vital parameters, level of sedation (Ramsay Sedation Scale 1–6), effect on respiration and surgeon satisfaction were assessed at regular intervals. Surgeon satisfaction score (0–3) was noted. Results: 'DEX half' group patients had predominantly stable haemodynamics, level 3 sedation and surgeon satisfaction score of 2–3 (good to excellent operating conditions). This group had no vomiting and no respiratory depression. 'DEX full' group had a higher incidence of bradycardia, hypotension, level 4 sedation (Ramsay Sedation Scale) and lower surgeon satisfaction. Incidence of nausea and vomiting was higher in MDZ:FEN group compared to other two groups. Conclusion: DEX 0.25 μg/kg loading dose over 10 min followed by titrated maintenance dose is an effective alternative to MDZ:FEN and provides controlled (level 3) sedation and stable haemodynamics maximising surgeon satisfaction. Avoiding narcotic analgesics with its associated post-operative nausea and vomiting is an additional benefit.


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