Indira Kumari, Udita Naithni, Vikram Bedi, Sapna Gupta, Rajesh Gupta D A, Bhuie M S.
Comparison of clonidine versus midazolam in monitored anesthesia care during ent surgery - a prospective, double blind, randomized clinical study.
Anesth Pain Intens Care Jan ;16(2):157-64.

Background: Monitored anaesthesia care (MAC) typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during various ENT surgical procedures. Aims: To compare the effectiveness and safety profile of clonidine against midazolam as an intravenously administered agent for MAC. Settings and design: Randomized, double blind, prospective study. Methodology: Sixty patients undergoing ENT surgery under MAC were divided into two groups of 30 patients each. The patients in Group C received clonidine 2 mcg/kg IV and in Group M received midazolam 20 mcg/kg IV over 10 min. Ramsay sedation score, requirement of intraoperative rescue sedation (propofol) and analgesic (diclofenac infusion), postoperative visual analogue score & analgesic requirement (tramadol), adverse effects, recovery profile (Aldrete Score) and satisfaction scores of patients and surgeon were recorded. Data were analysed by chi-square, student t test and analysis of variance using Epi info 6 with p value <0.05 as significant. Results: Mean Ramsay sedation score (RSS) was significantly more in Group M (2.50 ± 0.73) as compared to Group C (1.80 ± 0.85), p = 0.001. Intraoperative rescue sedation with propofol infusion (if RSS<3) was required by significantly higher number of patients in Group C (n=19, 63.4%) than in Group M (n=6, 20%), P=0.001. Intraoperative rescue analgesic requirement was significantly more in Group M (n =21, 70%) as compared to Group C (n=11, 36.6%), p=0.009. Intraoperative bleeding score was significantly less in Group C (1.93±0.80) than in group M (2.43±0.73), P=0.014. Postoperative VAS score was also significantly less in Group C than in Group M (2.28±1.9 vs. 3.28±1.81, P=0.041). Both patients and surgeon were more satisfied in Group C than in Group M (p=0.010 & 0.019 respectively). All patients had Aldrete score of 10 at the end of surgery in both groups. Conclusion: We conclude that clonidine along with rescue sedation using propofol infusion can be a better alternative to midazolam in MAC since it provides a calm patient with better intraoperative & postoperative analgesia, and a bloodless surgical field leading to increased satisfaction of both patient and surgeon.

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