Comparison of sedation effectiveness of remifentanil-dexmedetomidine and remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: A randomized clinical trial

Ayse Hande Arpacı, Fusun Bozkırlı

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 mg 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 mg kg-1 h-1) or midazolam (0.05-0.15 mg 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.
  • Key words: Dexmedetomidine, midazolam,remifentanil, monitored anesthesia care, mini mental state examination, cystoscopy

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