Original Research Article Indian Journal of Clinical Anaesthesia, 2016;3(2):179-183 179 A prospective randomized comparative study of dexmedetomidine and propfol for conscious sedation in middle ear surgery under monitored anaesthesia care Leena Goel 1,* , Megha Goel 2 1 Assistant Professor, 2 Medical Student, Dept. of Anaesthesia, Goa Medical College, Goa *Corresponding Author: Email: drhcgoel@gmail.com Abstract Introduction: Monitored Anesthesia Care (MAC) is proposed to be a suitable technique for middle ear surgery. Aim: In present study we compared the efficiency of dexmedetomidine and propofol as an adjunct to local anesthesia for in producing analgesia, sedation, variation in respiratory and hemodynamic responses, along with patients and surgeons satisfaction. Materials and Methods: Fifty patients were enrolled in this prospective, single blinded, randomized study. The patients were allotted randomly into two groups: dexmedetomidine (Group D) or propofol (Group D). Sedation was assessed with Ramsay Sedation Scale (RSS) value of 3. Different parameters observed included changes in hemodynamic and respiratory values, post- surgical recovery time, sedation analgesia, surgeons’ and patients’ satisfaction about quality of anaesthesia. Results: Both the drugs i.e. dexmedetomidine and propofol were found to be providing adequate sedation but propofol was related with increased need for rescue analgesia and less patient satisfaction. These results propose that dexmedetomidine provide sufficient sedation with analgesia with good surgeon and patient ease without any adverse effect for patients being operated for middle ear surgery under local anesthesia. Keywords: Dexmedetomidine, Propofol, Fentanyl, Sedation, Middle ear surgery. Access this article online Quick Response Code: Website: www.innovativepublication.com DOI: 10.5958/2394-4994.2016.00055.X Introduction A common middle ear surgery (MES) includes tympanoplasty, stapedectomy and mastoidectomy. Tympanoplasty involves reconstruction of a tympanic membrane with permanent perforation with or without reconstruction of ossicles. 1 Most of these middle ear surgeries are usually undertaken under local anesthesia. Many advantages are reported when these surgeries are undertaken under local anesthesia such as reduced bleeding, cost effectiveness, early recovery and postoperative analgesia. Beside that improvement in hearing can be assessed in patients undergoing stapedectomy surgeries on the table itself. Still many of the MES are performed under general anesthesia due to patient anxiety, fear of sudden patient movement of patient while crucial operative step being performed and advantages associated with hypotensive general anesthetic techniques. The most common patient discomfort under local anesthesia is patient’s anxiety caused by noise during surgery which may further increased if burr is used for drilling the bone along with dizziness and discomfort due to positioning of head and neck during surgery. 2,3 Pharmacologically Dexmedetomidine is a centrally acting α-2 adrenoceptor agonist. It has been increasingly used in monitored anesthesia care (MAC) as a sedative due to its analgesic property, “co- operative sedation” and lack of any respiratory depression. 4,5 It is known to significantly reduce opioid requirements both intra and post operatively. Its sympatholytic action can attenuate the anxiety induced stress reaction to surgery (tachycardia and hypertension) while maintaining hemodynamic stability 6 . Although safe, bradycardia and hypotension are the most predictable and frequent side effects which are advantageous to provide less bleeding during surgery therefore provide blood free surgical field, essential for microsurgical procedures. Propofol is also another widely used sedative- hypnotic having a rapid onset action, short recovery time with antiemetic and euphoric properties. 7 This study was conducted to accesses the comparative safety and efficacy of dexmedetomidine and propofol in producing sedation and analgesia, bloodless surgical field, hemodynamic and respiratory variation along with patient and surgeon satisfaction in patients undergoing middle ear surgeries under local anaesthesia. Materials and Methods Approval was obtained from institutional ethics committee to conduct present study. Detailed written informed consent from the participants was taken. Fifty patients of both sexes were enrolled. Patients having American Society of Anesthesiologists Grade (ASA) 1 or 2, aged 18-60 years and undergoing middle ear