• Mohd Asim Rasheed, Dinesh Chandra Punera, Mehar Bano, Urmila Palaria, Abhilasha Tyagi, and Shatrunjay Sharma.
• Department of Anaesthesiology and Critical Care, Era's Lucknow Medical College, Lucknow, India.
• Anesth Essays Res. 2015 May 1;9(2):167-72.

BackgroundMonitored anesthesia care (MAC) combines intravenous sedation along with local anesthetic infiltration or nerve block. Several drugs have been used for MAC, but all are associated with complications. Dexmedetomidine is a selective α2-adrenoceptor agonist with both sedative and analgesic properties and is devoid of respiratory depressant effects. Its short elimination half-life makes it an attractive agent for sedation during MAC.AimComparative evaluation of dexmedetomidine and midazolam for MAC.MethodsIn this prospective, randomized, double-blind study, 50 American Society of Anesthesiologist I and II patients undergoing a surgical or diagnostic procedure of <1 h requiring MAC were enrolled. Dexmedetomidine-ketamine (Group "KD") patients (n = 25) received intravenous (I.V.) dexmedetomidine 1 mcg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine. Midazolam-ketamine patients (n = 25) received I.V. midazolam 0.05 mg/kg over 10 min followed by 0.5 mg/kg of I.V. ketamine to get a targeted level of sedation (≤4 using Observer's Assessment of Alertness/Sedation Scale score). Inadequate sedation (e.g., 15% increase in mean arterial blood pressure or heart rate, decrease in degree of calmness, increase in respiratory rate, physical movement) was treated by a ketamine bolus of 0.5 mg/kg as a rescue analgesia.Statistical AnalysisThe statistical tests used in the study are unpaired Student's t-test for continuous variables and Chi-square test for categorical variables. Mann-Whitney test was used to assess the patient and surgeon satisfaction. Data were expressed as mean ± standard deviation. Value of P < 0.05 is considered significant and P < 0.0001 as highly significant.ResultsClinically desired sedation and analgesia was achieved earlier and better with dexmedetomidine. Patients and surgeons satisfaction were significantly higher with dexmedetomidine. The requirement of additional sedation and analgesia was less in dexmedetomidine (KD) group.ConclusionDuring MAC dexmedetomidine provides better sedation and analgesia than midazolam.

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