Abstract

Background: The interventions in facial surgery are specific, short, and very painful. The place of the surgery can compromise a patient’s airway. Surgeons prefer to give local infiltrative anesthetics, but during the surgery patients are nervous, stressed, restless and ask for drugs to be asleep/ask for sleep medication. Dexmedetomidine (Dex) as an agent for analgosedation can meet the needs of those patients. Dex is an alpha 2 adrenergic agonist with sedative, anxiolytic and analgesic properties; Midazolam (Mdz) is the most often used drug for classical sedation, a drug from the benzodiazepine group. Aims: The aim of this study was to compare the effects on circulation and respiration of two drugs, dexmedetomidine (Dex) and midazolam (Mdz). Blood pressure, Puls/ min, respiration/min, SpO2 , incidents of bradycardia, hypotension, hypoxia, and other complications were measured and compared in the two groups. Material and methods: Sixty patients for facial surgery who met the inclusion criteria were enrolled in the study. Due to a computed choice/option, patients were allocated to be sedated with Dex (n=30) or Mdz (n=30). After signing a written consent for inclusion in the study, prior to surgery all patients got two venous lines and were preoperatively monitored. Patients of Dex group received a bolus of Dex 1 mcg/kg given in 10 minutes. The sedation was maintained with an additional dose of Dex of 0.5 mcg/kg/h, which was disconnected at the end of the surgery. Patients of Mdz group received a bolus of Mdz of 0.03 mg/kg followed by an infusion of Mdz of 0.2 mg/kg/h, which was disconnected at the end of the surgery. The vital signs (ECG, BP, P/min, Res/min, SpO2 , ETCO2 , BIS) were monitored and noted on 5-minute intervals. Results: The obtained results were statistically analyzed. Demographic data showed homogeneity between the groups. All patients prior to procedural sedation got local infiltrative anesthesia with lidocaine 1%. There was insignificant difference in duration of the surgical procedure between the groups (p>0.05) and prolonged induction to sedation in the Dex group (10.6±2.7* vs. 1.9±1.7); p=0.01. Blood pressure of patients in the Dex group showed a significant decrease and was lower than that in the Mdz group (p=0.05). Also, P/ min in the Dex group was lower than in the Mdz group (74.45±14.84*vs. 84.13±12.88) p=0.03. The results from the monitored respiration showed a statistically significant decrease in respiration/minute in the Mdz group (p=0.05) and decrease in SpO2 , (p=0.02). Conclusion: We found that Dex, used as an agent for analgosedation for facial surgery, is a safe drug providing hypotension and mild bradycardia which are easy for treatment with vasoconstrictors and a sedation without effects on respiration. Patients in the Dex group were more comfortable, and their satisfaction was higher than in patients in the Mdz group.

Keywords

dexmedetomidine, midazolam, procedural sedation, respiration, mean arterial blood pressure