ABSTRACT
Monitored anaesthesia care [MAC] typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during various ENT surgical procedures. To compare the effectiveness and safety profile of clonidine against midazolam as an intravenously administered agent for MAC. Settings and design: Randomized, double blind, prospective study. Sixty patients undergoing ENT surgery under MAC were divided into two groups of 30 patients each. The patients in Group C received clonidine 2 mcg/kg IV and in Group M received midazolam 20 mcg/kg IV over 10 min. Ramsay sedation score, requirement of intraoperative rescue sedation [propofol] and analgesic [diclofenac infusion], postoperative visual analogue score and analgesic requirement [tramadol], adverse effects, recovery profile [Aldrete Score] and satisfaction scores of patients and surgeon were recorded. Data were analysed by chi-square, student t test and analysis of variance using Epi info 6 with p value <0.05 as significant. Mean Ramsay sedation score [RSS] was significantly more in Group M [2.50 +/- 0.73] as compared to Group C [1.80 +/- 0.85], p = 0.001. Intraoperative rescue sedation with propofol infusion [if RSS<3] was required by significantly higher number of patients in Group C [n=19, 63.4%] than in Group M [n=6, 20%], P=0.001. Intraoperative rescue analgesic requirement was significantly more in Group M [n =21, 70%] as compared to Group C [n=11, 36.6%], p=0.009. Intraoperative bleeding score was significantly less in Group C [1.93 +/- 0.80] than in group M [2.43 +/- 0.73], P=0.014. Postoperative VAS score was also significantly less in Group C than in Group M [2.28 +/- 1.9 vs. 3.28 +/- 1.81, P=0.041]. Both patients and surgeon were more satisfied in Group C than in Group M [p=0.010 and 0.019 respectively]. All patients had Aldrete score of 10 at the end of surgery in both groups. We conclude that clonidine along with rescue sedation using propofol infusion can be a better alternative to midazolam in MAC since it provides a calm patient with better intraoperative and postoperative analgesia, and a bloodless surgical field leading to increased satisfaction of both patient and surgeon