ABSTRACT
Considering the growing trend of laryngeal surgeries and the need to protect the airway during and after surgery, among several therapeutic regimens to induce sedation, two regimens of propofol-fentanyl and propofol-midazolam were compared in microlaryngeal surgeries. Forty ASA I-II class patients undergoing microlaryngeal surgeries and referring routinely for postoperative visits were randomly recruited into two groups. For all the patients, 0.5 mg/Kg of propofol was used as bolus and then, 50 mcg/Kg/min of the drug was infused intravenously. For one group, 0.03 mg/Kg bolus of midazolam and for the other group, 2 mcg/Kg bolus of fentanyl was administered in combination with propofol. Ramsay system was used in order to evaluate the effect of the two drugs in inducing sedation. The need for additional dose, blood pressure, heart rate, arterial blood oxygen saturation, and also recovery time and adverse effects such as nausea/vomiting and recalling intra-operative memories, were assessed. The patients in the two groups were not statistically different regarding the number of patients, age, sex, preoperative vital signs, the need for additional doses of propofol, systolic blood pressure and mean systolic blood pressure during laryngoscopy. However, mean systolic blood pressure 1 min after removal of laryngoscope returned faster to the baseline in midazolam group [p < 0.01]. Mean heart rate returned sooner to the baseline in fentanyl group following removal of stimulation. Besides, heart rate showed a more reduction following administration of fentanyl [p < 0.02]. Mean arterial blood oxygen saturation during laryngoscopy significantly decreased in fentanyl group [p < 0.05] compared to the other group. The time it took to achieve a full consciousness was shorter in midazolam group [p < 0.01]. Nausea/vomiting was significantly more prevalent in fentanyl group while the patients in midazolam group apparently experienced more of amnesia, comparatively [p < 0.01]. Inducing laryngeal block and local anesthesia using propofol-midazolam regimen is not only associated with a more rapid recovery and less recalling of unpleasant memories, but also better in preventing reduction of arterial oxygen saturation during laryngoscopy compared with propofol-fentanyl regimen
ABSTRACT
Complete regional anesthesia of larynx accompanied by sedation is used for microlaryngeal procedures performed in the vicinity of airway system. In this study we have compared the sedative effects of two combinations of sedative drugs during microlaryngoscopic surgery. 40 patients who were candidates for microlaryngoscopic surgeries were selected for this study. All patients were in ASA class I-II. At first Laryngeal anesthesia was given by using Lidocaine as superior Laryngeal block and scattering lidocaine as spray on the tongue and pharynx. Intratracheal block was done for all patients. All 40 patients received 0.5 mg/kg of propofol intravenously as bolus, followed by 50 microg/kg/min as an IV infusion. Patients were then randomly divided into two groups. Group I received 0.03 mg/kg of midazolam intravenously and group II received fentanyl 2 micro g/kg intravenously. Blood pressure, heart rate and oxygen saturation of arterial blood was checked in all patients after induction of sedation, one minute after initiating Laryngoscopy and one minute after relieving the Laryngoscope stimulation. Time of complete awareness and recovery and also side effects, such as shivering, nausea and vomiting were evaluated. Induction using Fentanyl and propofol was accompanied by a greater degree of bradycardia as compared to the midazolam group, [p<0.02]. In addition, decrease in the level of oxygen saturation during laryngoscopy was more marked in the fentanyl group [P <0.05]. During the entire procedure, blood pressure showed fluctuation in both groups but reverted to normal faster after eliminating the stimulation in the midazolam group. [P <0.01] Eye opening and complete awareness were faster in the midazolam group. [P <0.01] Nausea occurred in 2 patients of fentanyl group. Recall about the procedure was present in 50% of fentanyl group and 10% of midazolam group [P < 0.01]. Sedating patients by midazolam accompanied by Laryngeal block has faster recovery and less recall and also fewer episodes of arterial oxygen desaturation during microlaryngoscopic surgical procedures