Comparison between Effects of Propofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Md Enayet Karim Karim, RAM Mostafizur Rashid Mostafiz, Mohammad Saleh Akram Akram, Reza Ershad
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Abstract

Background: The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Objective: This study was undertaken to compare propofol and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methodology: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups designated as Propofol group (Group A, n=30), who received Propofol in a single dose of 0.5mg/kg and Dexmedetomidine group (Group B, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. The onset of sedation i.e. time from iv (intravenous) injection of propofol or dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P>0.05). Time of onset of sedation was significantly delayed in Dexmedetomidine group (P<0.05). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Propofol (P<0.05). Propofol was associated with significantly higher incidence of some adverse effects like pain in arm during drug administration than Dexmedetomidine (46.66% vs 10.0%, P<0.05). Significant percentage of patients was satisfied with dexmedetomidine than propofol (86.66% vs 13.33%, P<0.001). Conclusion: Duration of sedation is significantly longer with dexmedetomidine than propofol which is beneficial for the patient in single dose technique for sedation. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):65-70
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异丙酚与右美托咪定在蛛网膜下腔麻醉下择期剖宫产术中的镇静效果比较
背景:脊柱(蛛网膜下腔)麻醉的使用常常受到患者在手术过程中不愿意保持清醒的限制。目的:比较丙泊酚和右美托咪定在脊髓麻醉下择期剖宫产术中镇静起效和恢复、血流动力学作用、呼吸作用和不良反应。方法:这项随机临床试验包括60例ASA(美国麻醉师学会)一级患者,于2022年1月至2022年6月期间在蛛网膜下腔麻醉下进行选择性剖腹产。将患者随机分为两组:异丙酚组(A组,n=30)和右美托咪定组(B组,n=30),分别给予异丙酚单次剂量0.5mg/kg和右美托咪定单次剂量2mcg/kg。记录镇静的起效时间,即从静脉注射异丙酚或右美托咪定到闭眼时间(OAA/S评分为3)和镇静的觉醒时间,即从闭眼到OAA/S评分为5(患者临床清醒)的时间。记录手术过程中任何并发症。结果:两组患者在不同时间间隔的平均血压、平均心率差异无统计学意义(P>0.05)。右美托咪定组患者镇静起效时间明显延迟(p < 0.05)。右美托咪定的唤醒时间即镇静时间明显长于异丙酚(P<0.05)。异丙酚在给药期间手臂疼痛等不良反应的发生率明显高于右美托咪定(46.66% vs 10.0%, P<0.05)。右美托咪定满意率显著高于异丙酚满意率(86.66% vs 13.33%, P<0.001)。结论:右美托咪定的镇静时间明显长于异丙酚,有利于单剂量镇静。孟加拉国国家神经科学研究所杂志,2023年1月;9(1):65-70
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