Details
Category: Volume 08 Issue 02 February 2020
Hits: 1263

Title: Comparative Study between IV Dexmedetomidine versus IV Dexmedetomidine with Nalbuphine as an Adjuvant for Monitored Anesthesia Care in Tympanoplasty Surgeries

Authors: Sowjanya Tungana, A Satyanarayana

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.76

Abstract

Background and Aims:  Tympanoplasty surgeries are usually performed under Monitored Anaesthesia care (MAC).The  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 Nalbuphine to Dexmedetomidine.

Material & Methods: 100 patients of either sex, aged 18-20 years, ASA grade I&II were randomized into two groups (D and ND) of 50 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 ND received inj nalbuphine 50mcg/kg followed by Dexmedetomidine 1mcg/kg.Both groups received an infusion of inj. Dexmedetomidine @ 0.4 mcg/kg/hr. All patients were assessed for intraoperative haemodynamic changes, SpO2, 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 ND as compared to group D (p<0.001). RSS, in group ND was significantly higher as compared to group D throughout the surgery. Rescue sedation was given in 5 patients in group ND while in group D, 20 patients required additional sedation (p<0.01) .Rescue analgesic with iv fentanyl was administered in 8 patients and 42 patients respectively in groups ND and D.Patient and surgeon satisfaction scores were also significantly higher in group ND vs group D (p<0.001).

Conclusion: A combination of Dexmedetomidine with Nalbuphine as an adjuvant for Monitored Anaesthesia Care in microscopic ear surgery was found to provide superior sedoanalgesia.

Keywords: Monitored ansthesia care, Dexmeditomedine, Nalbuphine, Tympanoplasty.

References

  1. Sarmento KM Jr., Tomita S. Retroauricular tympanoplasty and tympanomast-oidectomy under local anesthesia and sedation. Acta Otolaryngol 2009;129:726-8.
  2. Caner G, Olgun L, Gültekin G, Aydar L. Local anesthesia for middle ear surgery. Otolaryngol Head Neck Surg 2005;133:295-7.
  3. Yung MW. Local anaesthesia in middle ear surgery: Survey of patients and surgeons. Clin Otolaryngol Allied Sci 1996;21:404-8.
  4. Liang S, Irwin MG. “Review of anesthesia for middle ear surgery. Anesthesiol Clin 2010;28:519-28
  5. Ghisi D, Fanelli A, Tosi M, Nuzzi M, Fanelli G.Monitored anesthesia care. Minerva Anestesiol 2005;71:533
  6. Lee JJ, Lee JH. Middle-ear surgery under sedation: Comparison of midazolam alone or midazolam with remifentanil. J Laryngol Otol 2011;125:561-6.
  7. Benedik J, Manohin A. Sedation for middle ear surgery:Prospective clinical trial comparing propofol and midazolam. Cent Eur J Med 2008;3:487-93.
  8. Gupta K, Bansal M, Gupta PK, Pandey MN, Agarwal S.Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field:A prospective study. Indian J Anaesth 2015;59:26‑
  9. Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesiapractice: A wonder drug? Indian J Anaesth 2011;55:323‑
  10. Lee JJ, Lee JH. Middle‑ear surgery under sedation: Comparison of midazolam alone or midazolam with remifentanil.J Laryngol Otol 2011;125:561‑
  11. Parikh DA, Kolli SN, Karnik HS, Lele SS, Tendolkar BA. Aprospective randomized double blind study comparing Dexmedetomidine vs. combination of Midazolam Fentanylfor Tympanoplasty surgery under monitored anesthesia care. J Anaesthesiol Clic Pharmacol. 2013Apr; 29(2):1738.
  12. Verma R, Gupta R, Bhatia VK, Bogra J, Agarwal SP. Dexmedetomidine and propofol for monitored anesthesia carein the middle ear surgery. Indian J Otol 2014;20:70‑
  13. Shrinivasa Rao Nallam et al Monitored anaesthesia care Comparison of Nalbuphine/ Dexmedetomidine versus Nalbuphine/Propofol for middle ear surgeries:A double blind randomized trial. November1, 2017, IP: 49.35.17.184.
  14. De La Mora González JF, Robles Cervantes JA, Mora Martínez JM, Barba Alvarez F, Llontop Pisfil EdeL, González Ortiz M, Martínez Abundis E, Llamas Moreno JF, Espinel Bermúdez MC. Hemodynamic effects of dexmedeto-midinefentanylvs. nalbuphinepropofolin plastic surgery. Middle East JAnaesthesiol. 2012 Feb;21(4):5537.
  15. Alka Kewalramani(Chhabra) et al “Comparative Evaluation of IV Dexmedetomidine versus Dexmedetomidine with Butorphanol as an Adjuvant for Monitored Anaesthesia Care in Tympanoplasty and Myringoplasty: A Prospective, Controlled, Randomized, Double Blind Study” Indian Journal of Clinical Anaesthesia, January-March,2016;3(1)
  16. Mohamed MH, Hakim KK. Comparative study between dexmedetomidine/ nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery. Egypt J Anaesth 2014;30:7-12.
  17. Eren G, Cukurova Z, Demir G, Hergunsel O, Kozanhan B,Emir NS. Comparison of dexmedetomidine and three differentdoses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol 2011;27: 367‑
  18. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.

Corresponding Author

Sowjanya Tungana

Post graduate student, Department of Anesthesiology, AMC, Visakhapatnam, Andhra Pradesh