title: Monitored anaesthesia care - Comparison of nalbuphine/dexmedetomidine versus nalbuphine/propofol for middle ear surgeries: A double-blind randomised trial.
abstract: OBJECTIVE
  Middle ear surgeries (MESs) are usually performed under sedation with local anaesthesia and can be well tolerated by the patient with minimal discomfort. In the present study, we compare the effect of nalbuphine/dexmedetomidine combination with nalbuphine/propofol on sedation and analgesia in monitored anaesthesia care.
  
  
  METHODS
  One hundred adult patients undergoing MESs under monitored anaesthesia care (MAC) were randomly allocated into two groups. All patients in both groups received injection nalbuphine 50 μg/kg intravenously (IV). Group D received a bolus dose of injection dexmedetomidine 1 μg/kg IV over 10 min followed by an infusion started at 0.4 μg/kg/h IV. GroupPreceived a bolus dose of injection propofol 0.75 mg/kg followed by an infusion started at 0.025 mg/kg/min IV. Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Patient's mean arterial pressure, heart rate, saturation peripheral pulse and need for intraoperative rescue sedation/analgesia were recorded and compared. The data analysis was carried out withZtest and Chi-square test.
  
  
  RESULTS
  Mean RSS was significantly more in Group D (4.24 ± 1.54) as compared to GroupP(2.58 ± 0.95). Overall VAS score was also significantly less in Group D (3.5 ± 1.7) than in GroupP(5.4 ± 1.8). In total, 16 patients (32%) in Group D had hypotension whereas 7 patients (14%) only in GroupPhad hypotension.
  
  
  CONCLUSIONS
  Nalbuphine/dexmedetomidine combination is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing MESs under MAC. Better surgeon and patient satisfaction were observed with nalbuphine/dexmedetomidine. Haemodynamics need to be closely monitored.
authors.affiliation: Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India.
authors.forename: Srinivasa Rao
authors.initials: SR
authors.lastname: Nallam
authors.affiliation: Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Chiruvella
authors.affiliation: Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India.
authors.forename: Anjineswar
authors.initials: A
authors.lastname: Reddy
keywords: Conscious sedation; dexmedetomidine; nalbuphine; propofol