The Sedative and Propofol-Sparing Effect of Dexmedetomidine and Midazolam as Premedicants in Minor Gynecological Day Care Surgeries: A Randomized Placebo-Controlled Study.

Background And Aims: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes. Hemodynamic parameters and side effects were evaluated as secondary outcomes.

Materials And Methods: A prospective randomized placebo-controlled study was conducted on 150 American Society of Anesthesiologists ASA physical status Classes I and II gynecological patients between 18 and 50 years and were allocated into three groups of fifty each. Group A received intravenous (i.v.) dexmedetomidine 0.1 μg/kg, Group B received i.v. midazolam 0.04 mg/kg, and Group C received normal saline 10 min before induction.

Results: Sedation score was statistically highly significant between Group A and B ( < 0.001). Between Group A and C, it was statistically significant ( < 0.05); however, score was nonsignificant between Groups B and C ( > 0.05). During recovery at 120 min after surgery, score 5 was achieved equally by all three groups which was found to be statistically insignificant ( > 0.05). Mean dose of additional propofol used was less in Group A (14 ± 9.25) than B (25 ± 5.40) and C (53 ± 10.96). On intergroup comparison between all three groups, it was found to be statistically highly significant ( < 0.001). Comparison of bispectral index (BIS) values between Groups A and C and Groups B and C were highly significant ( < 0.001). However, it was statistically significant between Groups A and B ( < 0.05). Aldrete scoring and street fitness scores were highly significant between Groups A and B, B and C, and also between Groups A and C ( < 0.001). No significant hemodynamic derangements and side effects were noted in any of three groups.

Conclusion: Dexmedetomidine had good sedation and better recovery characteristics than midazolam. BIS monitoring was helpful in maintaining the depth of anesthesia.