Jul 2026· Asian Journal of Pharmaceutical and Clinical Research· 0 citations
Abstract
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery.
Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed.
Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09).
Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
Both agents are effective for short procedural sedation, whereas propofol ensures faster recovery, and Dexmedetomidine offers superior cardiorespiratory stability, whereas propofol ensures faster recovery.
Vikash Gaurav· International Journal of Pha...· 0 citations
Background: Spinal anesthesia is a very commonly used procedure in modern-day anesthesia practice. Today most of the lower limb surgeries are performed under spinal anesthesia. Midazolam, dexmedetomidine, and fentanyl are common intravenous adjuvants used during anesthesia to allay anxiety and sedation. The aim of this study was to compare the effects of intravenous dexmedetomidine-midazolam versus fentanyl-midazolam in terms of analgesic characteristics, sedation, and adverse effects.
Methods: This is a randomized prospective study that included 35 patients in each group, posted for lower limb orthopedic surgery. Intravenous dexmedetomidine, fentanyl, and midazolam were administered after subarachnoid block. Data for sedation, analgesia, hemodynamic parameters, and adverse effects were recorded.
Results: RR for FM group showed significant intra-group variability in RR across perioperative stages (p<0.05), whereas the DM group maintained greater respiratory stability (p=0.243). HR for DM group exhibited significantly lower intraoperative and postoperative HR compared to FM group (p<0.001), with notable within-group changes, unlike the FM group. MAP for both groups remained stable over time (DM: p= 0.283, FM: p= 0.260), although the FM group had slightly higher values in the postoperative recovery phase. Sedation (RSS): DM produced deeper and more sustained sedation intraoperatively and postoperatively (p<0.001), while FM showed quicker sedation decline. Patient satisfaction was significantly higher in the DM group (VAS: 3.0 vs. 4.0, p= 0.001), although surgeon satisfaction did not differ notably. Adverse events were rare and comparable, though hypotension was more frequent in the DM group (22.9% vs. 8.6%).
Conclusion: Dexmedetomidine plus midazolam provided superior sedation quality and patient satisfaction, with more stable cardiopulmonary parameters during orthopedic surgery under spinal anesthesia. Despite a slightly higher rate of hypotension, DM appears to offer a more favorable sedative profile compared to fentanyl plus midazolam.
M. Rahimi, Mohamad Sorani, Afzal Shamsi et al.· Archives of Anesthesia and C...· 0 citations
Background:Functional Endoscopic Sinus Surgery (FESS) requires a clear and bloodless surgical field for optimal visualization and prevention of intraoperative complications. Controlled hypotension is commonly employed during FESS to reduce blood loss and improve surgical conditions. Dexmedetomidine and Propofol are widely used agents for controlled hypotensive anesthesia. The present study was conducted to compare the efficacy of dexmedetomidine and propofol infusion in achieving controlled hypotension during FESS.Methodology:This prospective randomized comparative study was conducted in the Department of Anaesthesiology at Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 100 patients aged between 18 and 40 years belonging to ASA Grade I and II undergoing elective FESS were included in the study. Patients were randomly allocated into two groups of 50 each. Group D received dexmedetomidine infusion at 0.4–0.8 μg/kg/hr, while Group P received propofol infusion at 75–100 μg/kg/min following induction of general anesthesia. Intraoperative pulse rate, mean arterial pressure, blood loss, quality of surgical field, sedation score, and complications were assessed and compared between the two groupsResults:Baseline demographic and hemodynamic parameters were comparable between the groups. Intraoperative pulse rate and mean arterial pressure were significantly lower in the dexmedetomidine group at various time intervals compared with the propofol group (p<0.05). Quality of surgical field and mean blood loss were comparable in both groups. Postoperative Ramsay sedation scores at 30 minutes were significantly higher in the propofol group (p=0.023). No major complications were observed in either group.Conclusion:Both dexmedetomidine and propofol were effective and safe agents for controlled hypotension during FESS. Dexmedetomidine provided superior intraoperative hemodynamic stability with comparable surgical field quality and blood loss, making it a useful alternative to propofol for hypotensive anesthesia in endoscopic sinus surgery.
Dr. Balakrishnan, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Objective: To compare intravenous Dexmedetomidine and Tramadol for control of shivering following spinal anaesthesia.
Methods: This prospective, randomised, double blind study was conducted in 60 adult patients aged 18 to 60 years with ASA physical status I or II undergoing elective surgery under spinal anaesthesia. Patients who developed grade 2 or higher shivering were randomly assigned to receive intravenous Dexmedetomidine 0.5 µg/kg or Tramadol 0.5 mg/kg infused over 20 minutes. Shivering severity was assessed using the Wrench scale. Statistical analysis compared continuous and categorical variables between groups, with significance set at p < 0.05.
Results: Demographic profile and baseline parameters were comparable between groups, with equal gender distribution and similar mean body weight. Time to cessation of shivering was shorter in the dexmedetomidine group (172.7 ± 20.7 seconds) compared with the tramadol group (272.4 ± 19.0 seconds). Shivering recurrence occurred in 6.7% of patients receiving dexmedetomidine and 23.3% receiving tramadol. A significant difference was observed at T3 for pulse rate (64.9 ± 8.1 vs 69.9 ± 7.5 bpm; p = 0.02) and diastolic blood pressure (74.9 ± 6.7 vs 79.9 ± 6.9 mmHg; p = 0.006).
Conclusion: Intravenous dexmedetomidine showed faster and more sustained control of post spinal anaesthesia shivering than tramadol. Slow infusion of both drugs maintained haemodynamic stability thus proving that dexmedetomidine is an effective option for shivering control during spinal anaesthesia.
JUHI KACHA, AKSHATA KHOMANE, JALARAM HARSHAPPAN et al.· Asian Journal of Pharmaceuti...· 0 citations
Objectives: The study aimed to compare the analgesic efficacy, hemodynamic effects, rescue analgesic requirements, and adverse-effect profile of intravenous paracetamol and intravenous tramadol for post-operative pain management in patients undergoing elective surgeries under general anesthesia.
Methods: This study is a prospective, randomized, assessor-blinded comparative study performed in the Department of Anaesthesiology at a tertiary care teaching hospital from March 2025 to March 2026. A total of 100 adult patients with American Society of Anesthesiologists physical status I-II undergoing elective surgical procedures under general anesthesia were randomly divided into two groups of 50 patients. At the end of surgery, Group P received intravenous paracetamol 1 g, and Group T received intravenous tramadol 100 mg. The Visual Analog Scale (VAS) was used to assess pain at 1, 2, 4, 6, 8, and 12 h post-surgery. Heart rate, mean arterial pressure (MAP), time to first rescue analgesia, total rescue analgesic consumption, and adverse effects were measured and compared between the groups.
Results: There were no significant differences in demographic and clinical baseline characteristics between the groups (p>0.05). The paracetamol group had significantly lower VAS scores at 4, 6, and 8 h postoperatively (p≤0.001). Patients treated with paracetamol had a significantly longer time to first rescue analgesia (8.1±1.6 vs. 6.0±1.4 h; p<0.001) and a significantly reduced consumption of diclofenac in the first 12 post-operative h (84±22 vs. 118±28 mg; p<0.001). From 2 h onward, there were significant decreases in heart rate and MAP in the paracetamol group (p<0.05). There were fewer adverse effects in the paracetamol group, and a higher percentage of patients in the paracetamol group reported no adverse effects (90% vs. 74%, p=0.035).
Conclusion: Intravenous paracetamol provided superior post-operative analgesia, prolonged analgesic duration, reduced rescue analgesic requirements, and demonstrated a more favorable safety profile compared to intravenous tramadol. It may be considered an effective and safe alternative for post-operative pain management following elective surgeries under general anesthesia.
SRINIVAS KURAHATTI, Rashmi C, AVINASH KAREKAL· Asian Journal of Pharmaceuti...· 0 citations
BACKGROUND
Adequate sedation during spinal anesthesia requires careful titration to avoid hemodynamic instability and respiratory complications. We hypothesized that intrathecal fentanyl, used as an adjunct to neuraxial anesthesia, would reduce dexmedetomidine requirements for conscious sedation. This study evaluated the effects of intrathecal fentanyl on the total dose of dexmedetomidine during spinal anesthesia.
METHODS
Sixty-four patients undergoing knee or ankle arthroscopy under spinal anesthesia were randomly assigned to two groups. The fentanyl group received 0.5% bupivacaine 10 mg with fentanyl 20 μg, whereas the control group received bupivacaine 10 mg with saline. After confirmation of sensory block, dexmedetomidine was infused at 1 μg/kg over 10 minutes and maintained at 0.1-1 μg/kg/hour to maintain a bispectral index (BIS) of 70 to 80. The primary outcome was the total dose of dexmedetomidine. Secondary outcomes included BIS values, Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores, mean blood pressure, and heart rate at predefined time points.
RESULTS
The total dose of dexmedetomidine did not differ significantly between the groups. The MOAA/S scores were significantly affected by group, time, and group-by-time interactions (p=0.003, p<0.001, and p=0.007, respectively). The BIS values were influenced by group (p=0.026) and time (p<0.001), but not by group-by-time interactions (p=0.413). Exploratory analyses suggested deeper sedation in the fentanyl group during the early phase of dexmedetomidine infusion. Hemodynamic variables were comparable between the groups.
CONCLUSION
Intrathecal fentanyl did not significantly reduce dexmedetomidine requirements during spinal anesthesia, although it was associated with deeper sedation at several time points.
K. B. Park, J. Yeom, Juhee Min et al.· Journal of Yeungnam Medical...· 0 citations
