A comparative study of sedation with dexmedetomidine or midazolam during spinal anesthesia

Abstract

Background: Regional anesthesia offers several benefits over general anesthesia. But to the patient it may be stressful as they stay awake. Sedation during regional anesthesia plays an important role in reducing the stress and patient satisfaction. It gives anxiolysis and amnesia. In contrast to general anesthesia, verbal contact is possible whenever necessary. Dreaming might be considered as the purest form of sub consciousness and it is purely subjective. The incidence of intraoperative dreaming has not been reported by many. We designed this random prospective study to compare 2 different IV sedation protocols midazolam and Dexmedetomidine with respect to dreaming during sedation under regional anesthesia.

Methodology:  One hundred and twenty adult patients were randomly assigned to 2 groups; Group M received IV inj midazolam and Group D received inj dexmedetomidine for sedation during spinal anesthesia. Sedation was assessed on Ramsay Sedation Score. Patients were interviewed on emergence and 30 minutes later to determine the incidence of dreams. Postoperatively, patient satisfaction with the sedation was also evaluated. The patients satisfaction was assessed using a scale from 1–100. Any untoward side effects were noted. Quantitative variables were compared between groups using Student's t-test. Data for heart rate and mean arterial pressure were analyzed using a Friedman test. Chi-square analysis was used for comparison of categorical variables.

Results:  60 patients in each group were included in the final analysis. The incidence of dreaming was 16 % in the midazolam group and 3% in the dexmedetomidine group. High level of satisfaction with the sedation was observed in dexmedetomedine group. In this group 66% patients expressed sedation as excellent, 11%- good and 15% termed it as satisfactory.  Midazolam was associated with decreased patient satisfaction; 26% patients termed it as excellent, 58% good and 15% satisfactory.

Conclusion: During spinal anesthesia with sedation, patients receiving midazolam had 5 times more dreaming than those receiving dexmedetomidine. However, dexmedetomidine provides better quality of sedation during regional anesthesia resulting in superior patient satisfaction than midazolam.

Key words: Dexmedetomidine; Midazolam; Dreaming; Sedation; Spinal anesthesia; Patient satisfaction

Citation: Nirmala BC, Sowmya G, Supriya DP, Vinita VT. A comparative study of sedation with dexmedetomidine or midazolam during spinal anesthesia. Anaesth Pain & Intensive Care 2016;20(3):328-333

This study has been registered in the MVJ Medical College and Research Hospital (MVJMCRH) Research & Studies, which comes under Rajiv Gandhi University of Health Sciences (RGUHS) Bangalore, Karnataka

RECEIVED: 30 MAY 2016; REVIEWED: 11 & 26 SEPTEMBER 2016; CORRECTED: 26 SEPTEMBER 2016; ACCEPTED: 29 SEPTEMBER 2016