Yong Peng LIM, Nurlia YAHYA, Azarinah IZAHAM, Esa KAMARUZAMAN, Muhammad Zurrusydi ZAINUDDIN, Wan Rahiza WAN MAT, Shereen Suet Ping TANG, Jaafar Md ZAIN, Siti Nidzwani MOHAMAD MAHDI

The comparison between propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia

Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia. Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety score, level of sedation using the Bispectral Index and Observer's Assessment of Alertness and Sedation, hemodynamic stability, and overall patient's feedback on anxiolysis were assessed. Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 min after starting surgery. Difference in median anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion. Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the propofol group (45.20%). Conclusion: Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol during regional anesthesia.

Keywords:

Regional anesthesia, anxiety, dexmedetomidine, propofol,

PDF

___

Senses E, Apan A, Kose EA, Oz G, Rezaki, H. The effects of midazolam and dexmedetomidine infusion on peri-operative anxiety in regional anesthesia. Middle East J Anaesthesiol 2013; 22: 35-40.
Haugen AS, Eide GE, Olsen MV, Haukeland B, Remme AR, Wahl AK. Anxiety in the operation theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. J Clin Nurs 2009; 18: 2301-2310.
Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth 2010; 104: 369-374.
Patki A, Shelgaonkar VC. A comparison of equisedative infusions of propofol and midazolam for conscious sedation during spinal anesthesia-A prospective randomized study. J Anaesthesiol Clin Pharmacol 2011; 27: 47-53.
Eren G, Cukurova Z, Demir G, Hergunsel O, Kozanhan B, Emir NS. Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol 2011; 27: 367-372.
Sun GC, Hsu MC, Chia YY, Chen PY, Shaw FZ. Effects of age and gender on intravenous midazolam premedication: a randomized double-blind study. Br J Anaesth 2008; 101: 632- 639.
Baraka AR, Sutcliffe N, Schwab M. Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia 2007; 62: 661- 666.
Karam Y, Vanda G, Aouad MM. Perioperative uses of dexmedetomidine. Middle East J Anesthesiol 2006; 18: 1043- 1058.
Kindle CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 2000; 90: 706-712.
Oudhoff JP, Timmermans DR, Knol DL, Bijnen AB, Van DW. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health 2007; 7: 164.
Latif A, Shamsher RM, Nawaz K. Depression and anxiety in patients undergoing elective and emergency surgery: cross-sectional study from Allama Iqbal Memorial Teaching Hospital, Sialkot. J Pak Med Assoc 2017; 67: 884-888.
Dipanjan B, Mohan CM, Sabyasachi D, Sekhar RB, Susanta S, Jyotirmoy D. Bispectral index score and observer’s assessment of awareness/sedation score may manifest divergence during onset of sedation: study with midazolam and propofol. Indian J Anaesth 2013; 57: 351-357.
Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol. Anesth Analg 2009; 109: 1811-1815.
Uddalak C, Suchismita M, Sarmila G, Susmita B, Subrata B, Hirak B. Comparison between propofol and dexmedetomidine on depth of anesthesia: a prospective randomized trial. J Anaesthesiol Clin Pharmacol 2014; 30: 550-554.
Wang HM, Shi XY, Qin XR, Zhou JL, Xia YF. Comparison of dexmedetomidine and propofol for conscious sedation in inguinal hernia repair: a prospective, randomized, controlled trial. J Int Med Res 2017; 45: 533-539.
Ghali A, Mahfouz AK, Ihanamaki T, El Btarny AM. Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon’s anaesthesia. Saudi J Anaesth 2011; 5: 36-41.
Gupta A, Parashar VK, Gupta A. Comparative study of dexmedetomidine and propofol for intraoperative sedation during surgery under regional anaesthesia. Int J Med Res Prof 2017; 3: 205-210.
Verma R, Gupta R, Bhatia VK, Bogra J, Agarwal SP. Dexmedetomidine and propofol for monitored anesthesia care in the middle ear surgery. Indian J Otol 2014; 20: 70-74
Shah PJ, Dubey KP, Sahare KK, Agrawal A. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: a comparative study. J Anaesthesiol Clin Pharmacol 2016; 32: 245-249.
Hannivoort LN, Eleveld DJ, Proost JH, Reyntjens KM, Absalom AR, Vereecke HE, Struys MM. Development of an optimized pharmacokinetic model of dexmedetomidine using target- controlled infusion in healthy volunteers. Anesthesiology 2015; 123: 357-367