A Randomized Control Trial of Three Intravenous Dexmedetomidine Doses for Procedural Sedation in Patients Undergoing Minor Gynecological Surgery

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Abstract (English)

Background: Minor surgery, despite its short duration, is associated with significant pain and discomfort. Several anaesthetic techniques and pharmacological agents have been used to reduce patient discomfort and facilitate surgical performance. However, procedural sedation and analgesia (PSA) is still preferred over general anaesthesia during short gynaecological procedures. Most analgesics/sedative drugs, such as midazolam, propofol, and fentanyl, which are commonly used for PSA, can potentially prolong sedation and cause respiratory depression and adverse hemodynamic effects, which may result in increased morbidity and unplanned hospitalization as most cases are done as day-care surgery. Dexmedetomidine, a known sedative and analgesic sparing drug that acts on α2 adrenoceptor, reduces heart rate, blood pressure, and anaesthetic drug requirements in response to any stress. Dexmedetomidine is extensively used as a sedative and analgesic agent in various surgeries, but the optimum dose of dexmedetomidine in these procedures is still unknown. Aim: The study aims to analyze a randomized control trial of three intravenous dexmedetomidine doses for procedural sedation in patients undergoing minor gynecological surgery. Method: The study was a randomized control trial conducted at Govt Medical Center & attached Bangur Hospital, Pali, Rajasthan, during the period March 2019 to December 2021. The study population consisted of ASA grade I and II patients aged 18-45 years who were scheduled to undergo short gynecological surgery (20-40 min) under intravenous sedation and analgesia. The study included hysteroscopic copper T removal, dilatation and curettage, hysteroscopic biopsy, and Bartholin cyst excision in the short gynecological surgery. The data was compiled, tabulated, and statistically analyzed using Statistical Product and Service Solutions (SPSS) version 17 (IBM Corp., Armonk, NY). Analysis of variance was used for the analysis of mean difference among groups and Chi-square test for grading of sedation, recovery, and discharge. Result: all patients had a Ramsay Sedation Score of 3 or more. In half of the patients in group A and in one-fourth of the patients in group B, ketamine was required as a rescue drug. None of the patients in group C required any drug supplementation. Moreover, the Modified Aldrete Score (≥8) was 21.14 ± 9.99 min and was almost doubled in groups B (39.68 ± 18.39 min) and C (45.38 ± 29.90 min). This difference was statistically significant in the A versus B group and the A versus C group (p = 0.000). However, it was comparable between groups B and C (p > 0.05). Patients in group A achieved PADSS score (≥9) earlier (148.64 ± 23.56 min) than in group B (177.10 ± 16.16 min) and group C (200.25 ± 18.47 min). Conclusion: Dexmedetomidine at a dose of 0.6 µg/kg/hr provides efficient sedation and analgesia but is associated with significant hemodynamic compromise, whereas dexmedetomidine at a dose of 0.4 µg/kg/hr requires ketamine supplementation at 0.3 mg/kg to achieve adequate analgesia and sedation without hemodynamic complications.