A Comparative Evaluation of Dexmedetomidine versus Midazolam-Fentanyl for Sedation in Ocular Surgeries under Peribulbar Anaesthesia in Children

Introduction: The general anaesthesia has been routinely used for children in ocular surgery. Midazolam????????fentanyl (MDZ: FEN) combination is frequently used for intravenous sedation in ophthalmic surgeries in adults and adolescents. Dexmedetomidine (DEX), an alpha 2 adrenoreceptor agonist is also indicated for procedural sedation for ophthalmic use at a loading dose of 0.5 microgm/kg over 10 min. However, it may cause deeper plane of sedation and thus surgeon dissatisfaction due to patient non-cooperation. Aims and objectives: We proposed to evaluate the efficacy and safety of low dose of dexmedetomidine (0.25 microgm/kg) versus midazolam-fentanyl (0.5mg/25microgm) for ocular surgeries under peribular anesthesia in children evaluate. Materials and methods: In a randomized, double-blind, prospective, interventional study, 60 patients (30 each group) aged 10-15 years, scheduled for any ocular surgery under peribulbar block were divided equally to receive either MDZ: FEN (0.5mg/25 microgm) or DEX (0.25 microgm/kg) dose over 10 mins. The vital parameters, effect on respiration, Ramsay sedation score were assessed at regular intervals and surgeon satisfaction score noted at end of the surgery. Results: The ???????DEX???????? group patients had stable haemodynamics, level 3 sedation and surgeon satisfaction score of 2????????3 (good to excellent operating conditions) with no respiratory depression. The incidence of nausea and vomiting was lower in DEX group as compared to MDZ: FEN group. Conclusion:: Low dose DEX (0.25 microgm/kg) over 10 min is an effective alternative to MDZ: FEN (0.5mg/25 microgm) and provides better (level 3) sedation score and stable haemodynamics, more surgeon satisfaction and no associated post????????operative nausea and vomiting as with the use of opioids. All patients were devoid of all known risk and complications associated with general anaesthesia