A Comparison of Effects of Dexmedetomidine-Ketamine versus Dexmedetomidine-Midazolam Combination in Ambulatory Transurethral Procedures
Authors:   Professor, Department of Anesthesiology, Banas Medical College and Research Institute, Palanpur, Gujarat 385001, India., Bhalabhai Rupakar Vinay , D Souza Rashmi ,   Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka 560034, India., Parth Shrenikbhai Shah ,   Consultant, Anesthesiologist, Zydus Hospital, Ahmedabad, Gujarat 380054, India.
Published: January 2024

Introduction: Minimally invasive transurethral procedures can be successfully performed on outpatient basis. The anaesthetic technique of choice for suchprocedures is Monitored Anaesthesia Care with a combination of local anaesthesia and sedation-analgesia. It ensures a rapid onset and early recovery with minimal cardiorespiratory adverse effects, facilitating same day discharge. Various drugs are being used in combination to achieve this goal. In this study, we have compared the effects of a combination of dexmedetomidine-ketamine and dexmedetomidinemidazolam in ambulatory transurethral procedures. Materials and Methods: This prospective, randomised, comparative study was carried out on sixty patients aged 20-60 years, of either sex, ASA I/II physical status, scheduled for elective, outpatient transurethral procedures. These patients were randomly allocated into two groups - Group DK received a bolus of IV ketamine 1mg/kg and IV dexmedetomidine 1µg/kg and Group DM received a bolus of IV midazolam 0.05mg/kg and IV dexmedetomidine 1µg/kg, bothwere followed by amaintenance infusion of dexmedetomidine 0.2µg/kg/hr IV throughout the procedure. The heart rate, mean arterial blood pressure, analgesia using Numerical Rating Scale and sedation using the Ramsay Sedation Scale were measured intraoperatively. The recovery characteristics were assessed using the Modified Aldrete Score, time to spontaneous eye opening and length of stay in the recovery room. Statistical analysis: The data was compared and analysed using the Unpaired t test and Fisher’s exact test. Results: Group DMshowed statistically significant lower mean arterial pressure (MAP) up to 35 mins duringthe procedure when compared with group DK (P <0.05). Although the sedation scores were similar, Numerical Rating Scale scores were significantly higher in group DM than in group DK till 10 minutes of the procedure (P <0.001). The Modified Aldrete score was higher and time to spontaneous eye opening, length of recovery room stay was shorter (P <0.001 andP <0.001, respectively) in group DK compared to group DM. The incidence of hypotension, bradycardia and postoperative nausea/vomiting was lower in group DK. Conclusion: Although, good sedation was seen with both the combinations, the dexmedetomidine-ketamine group provided better intra operative analgesia and cardiorespiratory stability with a shorter recovery time and lower incidence of post-operative nausea/vomiting. Thus, dexmedetomidine-ketamine combination is a better, safer alternative for monitored anaesthesia care in ambulatory transurethral procedures. Keywords: Dexmedetomidine; Ketamine; Midazolam; Ambulatory; Transurethral; Recovery.