Comparison of Midazolam and Dexmedetomidine for sedation in Postoperative intubated patients of head and neck surgery on spontaneous ventilation in Intensive care unit

Dr Ashok Chaudhari¹, Dr Amol Singam²*, Dr Ayushma Jejani³

¹Professor, Department of Anaesthesiology, Jawaharlal Nehru Medical College and AVBRH Hospital,

Sawangi, Meghe, Wardha.

²Professor and HOD, Department of Anaesthesiology, Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Meghe, Wardha.

³Junior Resident, Department of Anaesthesiology, Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Meghe, Wardha.

*Corresponding Author E-mail: drashokchaudhari@gmail.com, dramolsingam@gmail.com, jejaniayushma12@gmail.com

ABSTRACT:

Introduction: Sedation is important in the care of the critically ill and postoperative patients. Amount of drug and duration for which it is given, is important in determining patient outcome. Aim: Study aimed to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Methodology: This prospective, randomized, comparative study was conducted on 60 patients undergoing oromaxillofacial surgery who were randomized in two groups of 30 patients each. Group D received injection demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr (microgram/kilogram/hour) and Group M received injection midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr (milligram/kilogram/hour). The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO₂ and Ramsay sedation score at the start of sedation when the Ramsay sedation score (RSS) was I and time to extubation after stopping sedation. Results: Target sedation range was achieved in a mean duration of 10.36 ± 3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. Highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour whereas in midazolam group it was 2.83±0.38 which was observed at 6th hour of the study period. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. Conclusion: Injection dexmedetomidine is better as compared to injection midazolam for postoperative sedation.

KEYWORDS: Dexmedetomidine, Midazolam, Sedation, Intensive care unit, Intubated, Spontaneous ventilation, Maxillofacial surgery.

INTRODUCTION:

Sedation allows depression of patient’s awareness of the environment and reduction of their response to the external stimulation. It plays an important role in the care of the critically ill patients and postoperative patients. Amount of sedation given, and the duration for which it is given, is important in determining patient outcome as both over and under-sedation can have adverse effects. Over-sedation can increase the time on ventilatory support and prolong ICU duration of stay. Under-sedation can cause hyper-catabolism, immunosuppression, hypercoagulability, and increased sympathetic activity. Measure of sedation include subjective methods like Ramsay sedation score (RSS)¹ or the Riker sedation- agitation scale (RSAS)² and objective method like Bispectral index³. Ramsay sedation score is most commonly used tool for evaluation of sedation.

In oromaxillofacial surgeries, after the surgery there may be swelling and bleeding in the surgical area or the larynx which may result in respiratory tract obstruction⁴. Therefore there is a need to maintain the airway postoperatively and suitable depth of sedation for preservation of spontaneous respiration and endotracheal tube tolerance^5,6.

There are various routes of administration of sedation such as intramuscular, intravenous or subcutaneous etc. Intravenous technique has attained popularity due to ability to titrate the dose of sedative drug according to the response of the patient and quick onset of action⁷. Drugs such as benzodiazepines (lorazepam, midazolam), propofol and centrally acting α agonist (dexmedetomidine) are used for sedation in ICU. Midazolam is a water soluble, short acting benzodiazepine that is rapidly metabolised by the liver. Dose of midazolam for ICU sedation consists of loading dose of 0.05mg/kg over 10 minutes followed by maintenance dose of 0.1mg/kg/hr⁸. Dexmedetomidine is an alpha agonist which produces conscious sedation, hypnosis and analgesia with minimal effect on respiration. The recommended dose as per previous studies for sedation in ICU, is as loading dose of 1ug/kg over 10 minutes followed by continuous infusion of 0.2-0.7ug/kg/hr^9-13. Dexmedetomidine produces sedation similar to NREM sleep with good safety profile.

The purpose of this study was to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Primary objective was to compare the level of sedation by Ramsay Sedation Score (RSS) in injection dexmedetomidine and injection midazolam group and secondary objectives were to compare injection midazolam and injection dexmedetomidine with respect to time required to achieve target sedation range, hemodynamic stability, complications/ adverse drug reactions associated with them namely respiratory depression, withdrawal symptoms (agitation, nausea, vomiting, tremors).

MATERIALS AND METHODS:

After the approval from the institutional ethics committee, this prospective, randomized, comparative study was conducted in Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha over a period of 6 months (September 2018 to March 2019). Informed consent was obtained from all the patients included in the study.

ASA class I and II patients of either gender with age more than 18 years and less than 70 years, weighing within a range of 50-75kg, undergoing oromaxillofacial surgery under balanced anaesthesia and postoperatively on spontaneous ventilation, requiring sedation to tolerate endotracheal tube were included in the study.

All the patients with known allergy to dexmedetomidine or midazolam, known alcoholic, pregnant females, patients with head injury, status epilepticus, coma, acute unstable angina, acute myocardial infarction, sepsis, arrhythmias, severe hypotension, acute respiratory distress or hypoxemia, with recent administration of sedative or other CNS depressant drugs were excluded from the study.

60 patients undergoing oromaxillofacial surgery were prospectively randomized in two groups of 30 patients each. Randomization was performed by means of a computer generated random number table and allocation of the same in sealed envelope technique.

Group D (n=30): Sedation was maintained with injection dexmedetomidine

Group M (n=30): Sedation was maintained with injection midazolam

Armamentarium: Infusion pump, non invasive blood pressure monitor, oximetry monitor, stethoscope, 100% oxygen source and administration supplies, i.v supplies, emergency kits and required antedotes. (benzodiazepines – flumazenil).

All the patients were kept nil per orally from 12 midnight prior to day of surgery. All the patients were premedicated with tablet pantoprazole 40mg and tablet domperidone 10mg orally the previous night.

Intraoperative:

On arrival at the operation theatre, baseline heart rate, blood pressure, SpO₂ values were recorded. The patients were given inj. Midazolam 1mg i.v, inj. Glycopyrolate 0.2mg i.v and inj. Fentanyl 2μg/kg i.v. Induction was done with inj. Propofol 2mg/kg. Inj. vecuronium 0.1mg/kg was given intravenously to facilitate nasal endotracheal intubation using 7.5 or 8 no. cuffed armoured tube for males and 7 or 7.5 no. cuffed armoured tube for females. The endotracheal tube was secured after confirming the position of the tube by auscultation and end tidal CO₂. Following the placement of endotracheal tube, anaeshesia was maintained with 66% nitrous oxide in oxygen 2:1 ratio at fresh gas flow of 1.5 lit/min and sevoflurane 0.5-2% using closed circuit. Injection vecuronium was given in dose of 1mg intermittently to maintain neuromuscular blockade. Warming blankets were used to maintain normothermia. Electrocardiogram, blood pressure, SpO₂ and end tidal CO₂ were monitored throughout the procedure. At the end of the procedure, neuromuscular block was antagonized with neostigmine 0.05mg/kg i.v and glycopyrolate 0.01mg/kg. After the patient was fully conscious and following command, having spontaneous respiration, was then shifted to the post surgical intensive care unit with nasal endotracheal tube in-situ.

Postoperative:

On arrival at ICU, monitors such as electrocardiogram, pulse oximeter and non invasive blood pressure were attached to the patients and the readings were noted. RSS was also noted. Drug infusions were prepared by the personnel not involved in the study or the patient’s care.

Group D received injection Demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr and Group M received injection Midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr.

The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO₂ and Ramsay sedation score at the start of sedation when the Ramsay sedation score was I (T0), 1hr (T1), 2hr (T2), 3hr (T3), 4hr (T4), 5hr (T5), 6hr (T6), 8hr (T8), 10hr (T10), 12hr (T12). All the patients were maintained in a target sedation range of Ramsay sedation score 2-3. Time required to achieve target sedation was noted. Time required to achieve target sedation was defined as the increase in the Ramsay sedation score from 1 to 2 or 3. The dosages were adjusted to achieve the desired level of sedation as assessed by Ramsay sedation score. Dose of the infusion was tapered for last 2 hours to avoid withdrawal symptoms such as headache, nausea, vomiting, tremors. However the sedation score was still maintained between 2 and 3. In case of complications such as excessive sedation (RSS ≥ 4), the sedation was stopped, and measures such as mechanical ventilation and monitoring of vitals were considered, hypotension (systolic blood pressure less than 90mmHg or > 20% fall from the baseline) was treated with increase in the rate of intravenous fluid administration and inj mephentermine (3-6mg iv), bradycardia (heart rate < 60 /min) was treated with inj. atropine i.v 0.02mg/kg and any fall in the respiratory rate (< 10/min) was also noted. Injection fentanyl was given as a rescue analgesic in a dose of 1μg/kg whenever patient complained of pain and dose required was noted in each group.

After 12 hours, sedation was discontinued in preparation for extubation. Patients were extubated when they were wide awake, responding to simple commands, were hemodynamically stable, normothermic and respiratory rate >10/min but < 20/min, SpO₂ >98% on room air. Extubation time was defined as the time of discontinuation of infusion to extubation which was noted. Following parameters were monitored post extubation 2 hourly till 4 hours:

1. Heart rate

2. Systolic and diastolic blood pressure

3. SpO₂

4. Respiratory rate

5. Extubation time

6. Sedation level as assessed by Ramsay sedation score

7. Complications if any

Sample size was derived using openepi software. Assuming the average sedation score of 2.9 and SD of 1.19 keeping power at 80% and confidence interval of 95% (α error at 0.05), a sample size of 30 patients would be required to detect a minimum of 30% difference in the mean sedation score. Statistical analysis was performed with SPSS for windows (SPSS Inc, Chicago II, USA), version 16.0 for analysis of demographic data and comparison of groups. Descriptive data and comparison of groups, was done using paired T test. For all the tests “p” value of less than 0.05 was considered as statistically significant.

Table 2: Time required to achieve target sedation range, total dose of rescue analgesic and time to extubation

Variables	Group D (n=30)	Group M (n=30)	p value
Time required to achieve target sedation range (min)	10.36+3.05	7.43+4.36	0.00001 S
Total dose of rescue analgesic required	150mcg	450mcg	-
Time for extubation (min)	33.27+11.37	49.43+5.58	0.00001 S

The results observed in dexmedetomidine group are in contrast to midazolam group. (Table 2). There was statistically significant difference between the time required to achieve the target sedation (p<0.05) in the two groups. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The difference between the two groups with respect to time required for extubation was statistically significant (p< 0.05).

Graph 1: Comparison of heart rate (in beats per minute) amongst the two groups at various time intervals

The graph above (graph 1) shows that there was statistically significant difference (p< 0.05) in the mean heart rate between the two groups from first hour of start of sedation till two hours post extubation. In dexmedetomidine group, the percentage fall in the mean heart rate was 16-18% from the baseline and was maximum at the 6th hour. In midazolam group, percentage fall in the mean heart rate was around 5-8% from the baseline with maximum fall at 2nd hour

Graph 2: Graphical representation of comparison of SBP (systolic Blood Pressure) at various intervals between the two groups

The graph above (graph 2) shows that there was statistically significant difference (p< 0.05) in the mean systolic blood pressure between the two groups from second hour of start of sedation till two hours post extubation. In dexmedetomidine group, the percentage fall in the mean systolic blood pressure was 15-16% from the baseline and was maximum at the 2nd hour. In midazolam group, percentage fall in the mean systolic blood pressure was around 7-8% from the baseline with maximum fall at 1st hour.

Graph 3: Graphical representation of comparison of diastolic blood pressure (DBP) between the two groups at various time intervals.

The graph above (graph 3) shows that there was statistically significant difference (p< 0.05) in the mean diastolic blood pressure between the two groups from first hour of start of sedation till two hours post extubation. In dexmedetomidine group, the percentage fall in the mean diastolic blood pressure was 16-20% from the baseline and was maximum at the 2nd hour. In midazolam group, percentage fall in the mean diastolic blood pressure was around 9-15% from the baseline with maximum fall at 1st hour.

Graph 4: Graphical representation of comparison of Ramsay sedation scores of both groups

Graph above (graph 4) shows the distribution of patients in the two groups with respect to mean sedation scores. Infusion of the study drug was started when the patient was in RSS Score 1 after admission in ICU. Highest value of RSS score in dexmedetomidine group was 2.43 ±0.50, which was observed at the 4th and 10th hour. Highest value of RSS score in midazolam group was 2.83±0.38 which was observed at 6th hour of the study period. No patient in Group D and Group M had RSS Score >4. Overall RSS score in Group D was lower as compared to Group M, throughout our study period.

DISCUSSION:

Sedation is not only important in ICU but it is equally important in various medical and surgical procedures. Srivastava et al¹⁴compared dexmedetomidine, propofol and midazolam for short term sedation in postoperatively mechanically ventilated neurosurgical patients and Liao et al¹⁵compared dexmedetomidine and midazolam for conscious sedation in postoperative patients undergoing flexible bronchoscopy. However in our study we have used only dexmedetomidine and midazolam for sedation in spontaneously breathing postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ in ICU.

Both the groups in our study were comparable to each other with respect to age, weight, ASA class, gender and duration of surgery.

Target sedation range was achieved in a mean duration of 10.36±3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. There was statistically significant difference between the time required to achieve the target sedation (p<0.05) in the two groups. We observed that the median time to achieve target sedation was significantly lesser in midazolam as compared to dexmedetomidine group. The distribution half life of dexmedetomidine is short about 6 minutes which results in rapid onset of sedation. In accordance with the results of our study, other studies also found the same results.

Our study showed that there was statistically significant difference (p< 0.05) in the mean heart rate between the two groups from first hour of start of sedation till two hours post extubation. In dexmedetomidine group, the percentage fall in the mean heart rate was 16-18% from the baseline and was maximum at the 6th hour. In midazolam group, percentage fall in the mean heart rate was around 5-8% from the baseline with maximum fall at 2nd hour. In a study by Srivastava et al¹⁴, the heart rate was significantly lower in the dexmedetomidine group as compared to that in midazolam and propofol group (p<0.01) at 1^st hour after the admission to ICU. After extubation as well the heart rate was significantly lower in dexmedetomidine group as compared to propofol and midazolam group (p<0.001).

In our study the two groups showed statistically significant difference (p< 0.05) in the mean systolic and diastolic blood pressure values. In dexmedetomidine group, the percentage fall in the mean systolic blood pressure was 15-16% from the baseline and was maximum at the 2nd hour and percentage fall in the mean diastolic blood pressure was 16-20% from the baseline and was maximum at the 2nd hour. In midazolam group, percentage fall in the mean systolic blood pressure was around 7-8% from the baseline with maximum fall at 1st hour and percentage fall in the mean diastolic blood pressure was around 9-15% from the baseline with maximum fall at 1st hour. A parallel study by Mishra N. et al¹⁵shows that systolic blood pressure between dexmedetomidine and midazolam group was comparable during bolus dose period. However during intraoperative period when maintenance dose was being administered, systolic blood pressure was significantly lower in dexmedetomidine group (125.8±13.41, p <0.05). The blood pressure was comparable at 120 min of recovery period (p>0.05). The diastolic blood pressure between dexmedetomidine and midazolam group was comparable during bolus dose period. However during intraoperative period when maintenance dose was being administered, diastolic blood pressure was significantly lower in dexmedetomidine group (80.33±8.07, p<0.05). The diastolic blood pressure was comparable at 120 min of recovery period (p> 0.05).

In our study highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour. Highest value of RSS score in midazolam group was 2.83±0.38 which was observed at 6th hour of the study period. RSS Score was comparable in both the groups at 2nd, 5th and 12th hour of the study and it was statistically non-significant. No patient in Group D and Group M had RSS Score >4. Overall RSS score in Group D was lower as compared to Group M, throughout our study period. In a similar study by Senoglu et al⁸, intragroup data reveals that RSS significantly increased compared to baseline after loading dose (p<0.05) in both groups, between groups RSS levels were significantly lower at 2 hours after the loading dose in dexmedetomidine (2.1±0.3) group as compared to midazolam (2.5±0.7). RSS levels were significantly lower beginning from the 4th hour (2.3±5) in dexmedetomidine group as compared to midazolam (2.9±0.8), (p<0.05). In another study by Mishra et al¹⁵, RSS was comparable during loading as well as intraoperative maintenance dose periods in both groups. The RSS persistently increased in both the groups from the start of the loading dose to 10 minutes during loading dose. The mean RSS during intraoperative maintenance dose infusion had minimum value of 2.79 for group Dexmedetomidine and 2.82 for group Midazolam, while the maximum value was 3.54 and 3.55 respectively. Hence the RSS was comparable between the two groups.

Values of respiratory rate and oxygen saturation were comparable between the two groups in our study. A study by Mishra et al15, showed that neither dexmedetomidine nor midazolam caused respiratory depression. Saturation during the loading dose and recovery period were comparable between dexmedetomidine and midazolam group but during intraoperative maintenance dose period SpO2 was less in group Dexmedetomidine from 15 to 60 minutes. Although, saturation was lower in group dexmedetomidine, it never reached below 95%.

Only 2 patients in dexmedetomidine group required rescue analgesic at 4th hour. Whereas 4 patients required rescue analgesic in case of midazolam group- 2 patients required rescue analgesic at 4th hour and two of them required rescue analgesic at 2nd and 10th hour. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. In a parallel study by Srivastava et al¹⁴, it was seen that the mean fentanyl dose requirement was significantly less in dexmedetomidine group (0.26±0.13 mcg/kg/hr) as compared to propofol (0.50±0.14 mcg/kg/hr) and midazolam (0.42±0.14mcg/kg/hr) group (p<0.001). The results are parallel to our study. In another study by Riker et al⁹, it was seen that 180 patients out of 244 in dexmedetomidine group and 97 out of 122 patients in midazolam group were treated with fentanyl as rescue analgesic. The mean fentanyl dose requirement was significantly less in dexmedetomidine group (6.4mcg/kg/hr) as compared midazolam (9.6mcg/kg/hr) group (p=0.27). The result of this study is similar to our study showing that dexmedetomidine reduces the analgesic dose requirement.

The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. The difference between the two groups with respect to time required for extubation was statistically significant (p<0.05). Hence the time required for extubation after cessation of sedation was more in midazolam group as compared to dexmedetomidine group. In a study by Srivastava et al¹⁴, extubation time was least with propofol group (26.13±5.32min) as compared to dexmedetomidine (35.28±5.92min) and midazolam (48.21±7.23min) group (p<0.001). The extubation time were similar and rapid with the use of dexmedetomidine and propofol as compared to midazolam. There was no respiratory adverse event after extubation in either group and no patient required reintubation. In a study by Riker et al⁹, (prospective, double blinded randomized trial in 68 centers in 5 countries, in 375 ICU patients with mechanical ventilation for more than 24 hours to compare the efficacy and safety of prolonged sedation with dexmedetomidine and midazolam) it was observed that median time to extubation was 1.9 days shorter in dexmedetomidine (3.7 days) as compared to midazolam (5.6days) group. Hence dexmedetomidine treated patients spent less time on ventilators. Both the show results that are parallel to our study. Just like our study.

CONCLUSION:

Thus it was concluded that injection Dexmedetomidine is better as compared to injection midazolam for postoperative sedation. Dexmedetomidine has better safety profile, better sedation efficacy as inferred from lesser dose requirement as well as lesser dosage adjustments, better hemodynamic stability, shorter extubation time, lesser analgesic requirement, no incidence of respiratory depression as well as no other significant side effects.

REFERENCES:

1. Ramsay M, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalonealphadolone. Br Med J. 1974;2: 656–659.

2. Riker RR, Picard J, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999;27: 1325–1329.

3. Glass PS, Bloom M, Kearse L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86: 836–847Orr DL II. The development of anaesthesiology in and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2013;25: 341-355.

4. Orr DL II. The development of anaesthesiology in and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2013;25: 341-355.

5. Ohata H, Tanemura E, Dohi S. Use of high-dose dexmedetomidine infusion for anesthesia and sedation in a patient for micro laryngeal surgery maintained with spontaneous breathing. Masui. 2008;57: 428–432.

6. Gupta S, Singh D, Sood D, Kathuria S. Role of dexmedetomidine in early extubation of the intensive care unit patients. J Anaesthesiol Clin Pharmacol. 2015;31: 92–98.

7. Lacombe GF, Leake Jl, Clokie CM, Haas DA. Comparison of remifentanil with fentanyl for deep sedation in oral surgery. J Oral Maxillofac Surg. 2006;64: 215-22.

8. Senoglu N, Oksuz H, Dogan Z, Yildiz H, Demirkiran H, Ekerbicer H. Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: a randomized, double-blind, prospective study. Current Therapeutic Research. 2010 Jun 1;71(3):141-53.

9. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301: 489–499.

10. Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298: 2644–2653.

11. Ruokonen E, Parviainen I, Jakob SM, Nunes S, Kaukonen M, Shepherd ST, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35: 282–290.

12. Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother. 2009;43: 2064–2074.

13. Guinter JR, Kristeller JL. Prolonged infusions of dexmedetomidine in critically ill patients. Am J Health Syst Pharm. 2010;67: 1246–1253.

14. Srivastava VK, Agrawal S, Kumar S, Mishra A, Sharma S, Kumar R. Comparison of dexmedetomidine, propofol and midazolam for short-term sedation in postoperatively mechanically ventilated neurosurgical patients. Journal of Clinical and Diagnostic Research: JCDR. 2014 Sep;8(9):GC04.

15. Mishra N, Birmiwal KG, Pani N, Raut S, Sharma G, Rath KC. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam. National Journal of Maxillofacial Surgery. 2016 Jul;7(2):178.

Received on 11.04.2020 Modified on 25.06.2020

Research J. Pharm. and Tech. 2021; 14(5):2557-2562.

DOI: 10.52711/0974-360X.2021.00450

Variables	Group D (n=30)	Group M (n=30)	p value
Age(yrs)	46.86+11.98	40.87+15.12	0.0942 NS
Weight(kg)	66.93+2.33	65.83+2.2	0.065 NS
Gender (M:F)	24:06	26:04	0.490 NS (x²= 0.30)
ASA class (I:II )	15:15	09:21	0.580 NS (x²= 0.30)
Duration of surgery (min)	386+28.11	381.67+37.42	0.6144 NS