Background and Aims:  Tympanoplasty surgeries are usually performed under Monitored Anaesthesia care (MAC).The  selective α2 agonist dexmedetomidine, known for its opioid sparing effect along with sedative, analgesic hypotensive and anaesthetic properties with minimal respiratory depression has been used as a sole agent to provide MAC in various surgical interventions. The present study is aimed to evaluate the role of Dexmedetomidine as a sole sedoanalgesic agent and compare the efficacy of adding an adjuvant like Nalbuphine to Dexmedetomidine.

Material & Methods: 100 patients of either sex, aged 18-20 years, ASA grade I&II were randomized into two groups (D and ND) of 50 patients each for microscopic ear surgery under Local Anaesthesia (LA) with MAC. Group D received inj. Dexmedetomidine 1 mcg/kg iv loading dose while Group ND received inj nalbuphine 50mcg/kg followed by Dexmedetomidine 1mcg/kg.Both groups received an infusion of inj. Dexmedetomidine @ 0.4 mcg/kg/hr. All patients were assessed for intraoperative haemodynamic changes, SpO2, Ramsay sedation score(RSS), and visual analogue scale(VAS).Rescue doses of sedatives, analgesics, satisfaction scores(Patients and Surgeons) were compared in both the groups. Data was analyzed using chi-square and t-test. p value <0.05 was considered significant.

Results: Mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were significantly decreased from baseline in group ND as compared to group D (p<0.001). RSS, in group ND was significantly higher as compared to group D throughout the surgery. Rescue sedation was given in 5 patients in group ND while in group D, 20 patients required additional sedation (p<0.01) .Rescue analgesic with iv fentanyl was administered in 8 patients and 42 patients respectively in groups ND and D.Patient and surgeon satisfaction scores were also significantly higher in group ND vs group D (p<0.001).

Conclusion: A combination of Dexmedetomidine with Nalbuphine as an adjuvant for Monitored Anaesthesia Care in microscopic ear surgery was found to provide superior sedoanalgesia.

Keywords: Monitored ansthesia care, Dexmeditomedine, Nalbuphine, Tympanoplasty.

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Sowjanya Tungana

Post graduate student, Department of Anesthesiology, AMC, Visakhapatnam, Andhra Pradesh