Comparison of Premedication with Midazolam and Dexmedetomidine on Sedation and Anxiety in Controlled Hypertensive Patients Undergoing Elective Surgery under General Anaesthesia
Abstract
Background: The study is a double-blind randomized trial aiming to compare intravenous midazolam and dexmedetomidine as premedication for sedation and anxiety control in controlled hypertensive patients undergoing elective surgery under general anaesthesia.
Methods: The patients who met the inclusion criteria were randomly divided into two groups of 50 patients each. Thirty minutes prior to induction, Group 1 patients received midazolam 0.02mg/kg i.v and Group 2 patients received dexmedetomidine 1mcg/kg i.v in 100 ml normal saline over 10 minutes. Preoperative sedation and anxiety levels and vital parameters (heart rate, blood pressure, respiratory rate, arterial oxygen saturation) were assessed for 30 min at every 5 minutes interval.
Results: Preoperative sedation was found to be better with dexmedetomidine as compared to midazolam. Decrease in anxiety was comparable in both the groups. Significant fall in heart rate was observed in dexmedetomidine group but it was within the acceptable limits for age. Mean arterial pressure was comparable in both the groups. There was no statistical difference between the groups with respect to respiratory rate and arterial oxygen saturation.
Conclusion: Dexmedetomidine provides better sedation and good anxiety control with better maintainence of hemodynamic parameters as compared to midazolam. Thus it is a safe and effective drug to be used for premedication in controlled hypertensive patients.
[2] Lee IO, Kim YS, Chang HW, Kim H, Lim BG, Lee M. In vitro investigation of the effects of exogenous sugammadex on coagulation in orthopedic surgical patients. BMC Anesthesiol. 2018; (1):1-6.
[3] Maze M, Tranquili W. Alpha-2 adrenoreceptor agonist:s: defining the role in clinical anesthesia. Anesthesiology. 1991; 74(3):581-605.
[4] Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorien J, Korttila K. Intramuscularly administered dexmedetomidine attenuates heamodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg. 1992; 75(6):932-9.
[5] Roizen MF. Should we all have a sympathectomy at birth? Or at least preoperatively? Anesthesiology 1988; 68(4):482-4.
[6] Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand. 2008; 118(2):69-86.
[7] Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs. 1984; 28(6):519-43.
[8] Khanderia U, Pandit SK. Use of midazolam hydrochloride in anesthesia. Clin Pharm 1987; 6(7):533-47.
[9] Jones CR. Perioperative uses of dexmedetomidine. Int Anesthesiol Clin. 2013; 51(2):81-96.
[10] Reves JG, Glass PSA, Lubarsky DA, McEvoy MD, Martinez-Ruiz R. Intravenous Anesthetics. Miller’s Anesthesia,7thedition 2010;751–7.
[11] Ghignone M, Calvillo O, Quintin L. Anesthesia and Hypertension: The effect of clonidine on perioperative hemodynamics and isoflurane requirements. Anesthesiology. 1987; 67(1):3-10.
[12] Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg. 2010; 110(1):47-56.
[13] Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev. 2009; (4):CD004126.
[14] Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anesthesiol. 2012; 62:125-33.
[15] Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2(5920):656-9.
[16] Hornblow AR, Kidson MA. The visual analogue scale for anxiety: a validation study. Aust N Z J Psychiatry. 1976; 10(4):339-41.
[17] Sajid B, Mohamed T, Jumaila M. A comparison of oral dexmedetomidine and oral midazolam as premedicants in children. J Anaesthesiol Clin Pharmacol. 2019; 35(1):36-40.
[18] Diwan G, Bharti AK, Rastogi K, Gupta PK. Comparison of intranasal dexmedetomidine and midazolam as premedication in pediatric surgical patients: A prospective, randomized double-blind study. Anesth Essays Res. 2020; 14(3):384.
[19] Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth. 2006; 96(6):722-6.
Files | ||
Issue | Vol 8 No 4 (2022): Autumn | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v8i4.10175 | |
Keywords | ||
Midazolam Dexmedetomidine Ramsay Sedation Score Visual Analog Scale |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |