Dexmedetomidine infusion for conscious sedation in fess for mucormycosis

ABSTRACT

Aim of study To study the efficacy and safety of dexmedetomidine infusion for conscious sedation in post-covid patients for FESS. Method: we conducted a prospective study of 96 post-covid patients with mucormycosis posted for bilateral FESS after standard approval from the ethical committee in our institute. The patients included were ASA Grade I-3 presenting 4 to 6 weeks after covid infection. 78 out of 96 patients were severely diabetic with mean HbA1c between 8 to 9. 48 patients had severe lung infection with a CT severity scoring > 15/25. Surgery was performed under local anaesthesia with 2% lignocaine and adrenaline infiltration. Patient was premedicated with injection glycopyrrolate 0.2 mg, intravenous midazolam 0.03- 0.05 mg/ kg and intravenous fentanyl 1-2 μg/kg. Intravenous dexmedetomidine infusion was started preoperatively. initial loading dose was a bolus of 1 μg/kg over 20 minutes followed by a continuous infusion of 0.5 μg/kg intraoperatively. The entire surgery was conducted under local anaesthesia with sedation in 90 patients. General anaesthesia was given in 6 patients because of patient non- cooperation and increased bleeding. Observation Dexmedetomidine is a potent selective alpha 2 adrenergic agonist. It caused dosedependent sedation and anxiolysis, potentiation of opioid analgesia, minimal respiratory depression and had additional antisialagogue, antitussive and sympatholytic properties. Its use improved the surgical field significantly without compromising patient safety. 10 patients developed bradycardia/ hypotension intraoperatively, so the infusion was discontinued. Conclusion: Easy administration of dexmedetomidine and lack of toxic side effects while maintaining adequate perfusion of vital organs makes it a near-ideal hypotensive agent. Its additional antiinflammatory property is particularly beneficial in post-covid patients. It is an invaluable adjunct In cases where general anaesthesia is avoided. We conclude that dexmedetomidine plays a pivotal role in conscious sedation for FESS.