Journal of Research in Medical Sciences (Jan 2013)
Comparison of sedation effectiveness of remifentanil-dexmedetomidine and remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: A randomized clinical trial
Abstract
Background: The aim of the study is to compare the effects of remifentanil/dexmedetomidine and remifentanil/midazolam combinations in monitored anesthesia care (MAC) during cystoscopies. Materials and Methods: Forty patients who received remifentanil infusion of 0.05 μg kg-1 min -1 for cytoscopy procedure were randomized into two groups: Either dexmedetomidine 1 mg kg -1 (Group D) or midazolam 0.2 mg kg -1 h -1 (Group M) was administered intravenously for the first 10 min. Subsequently, anesthesia was maintained by using the bispectral index as a continuous infusion of dexmedetomidine (0.2-0.7 μg kg-1 h -1) or midazolam (0.05-0.15 μg kg-1 h -1 ). Heart rate, mean arterial pressure, mini-mental state examination findings, levels of sedation andanalgesia, and the patient′s and surgeon′s satisfaction were recorded. Results: Successful sedation and analgesia were achieved in all the patients. We were able to reach the target sedation level faster in Group D (P<0.0001). In Group D, the cognitive functions were less affected than in Group M (P<0.0001). Patient′s and surgeon′s satisfaction were significantly higher in Group D. Conclusion: The targeted sedation levels were achieved in a shorter period with dexmedetomidine-remifentanil compared to midazolam-remifentanil. The dexmedetomidine-remifentanil combination was observed to affect the cognitive functions less than midazolam-remifentanil did with shorter recovery times. Besides, patient′s and surgeon′s satisfaction rates were superior with dexmedetomidine-remifentanil. It was concluded that dexmedetomidine-remifentanil may be a combination of choice for monitored anesthesia care applications in outpatient surgical procedures of short duration.
