Comparison of the use of midazolam, dexmedetomidine and remifentanil in systoscopies for sedative action, analgesia and post-operative cognitive functions

In this study, we aimed to compare the effects of remifentanil-midazolam and remifentanil-dexmedetomidine combinations on hemodynamic parameters, sedation, analgesia, post-operative cognitive functions, recovery and patients? as well as surgeons? satisfaction rates during cystoscopies.Forty cases in ASA I-II risk groups aged between 20-70 years were randomly divided into two groups to receive either midazolam plus remifentanil (Group M, n=20) or dexmedetomidine plus remifentanil (Group D, n=20). The preoperative cognitive functions of the cases were assigned with mini-mental state examination (MMSE). In the operation room, in addition to remifentanil infusion of 0.05 µg/kg/min, group M received midazolam infusion of 0.2 mg/kg/h whereas group D received dexmedetomidine infusion of 1 µg/kg for the first 10 minutes. After ten minutes, maintenance infusions of midazolam 0.05-0.15 mg/kg/h and dexmedetomidine 0.2-0.7 µg/kg/h were added to the fixed infusion of remifentanil 0.05 µg/kg/min for Group M and Group D, respectively. After the first ten minutes, cases having BIS levels between 70 and 90 were placed to lithotomy position on the operating table and the procedure was started after administrating 10 ml of lubricating gel with local anesthetic to the uretra. The drug doses were adjusted to keep the BIS levels between 70 and 90. At the end of the procedure, the drug infusions were stopped and the discontinuation time of infusion was accepted as the beginning of the postoperative period (0 second). Patients were returned to supine position and those having BIS levels higher than 90 were sent to recovery room and were observed for one hour. KAH, OAB, SpO2, ETCO2, SS, BIS, OAA/S (Observer assessment of the alertness/sedation scale), VNS (Visual numeric scale) values were recorded during pre-and peroperative periods; rate of surgeons? satisfactions were recorded after the procedure; and KAH, OAB, SpO2, VNS and OAA/S values as well as the side effects observed during and after the drug administration, the medications were recorded in the recovery room. MMSE was applied in the postoperative 10th and 45th minutes.In summary; successful sedation and analgesia was achieved in all patients under monitored anesthesia care (MAC). No difference was observed regarding analgesia levels in hemodynamically stable patients. We were able to reach to the targeted sedation levels faster with dexmedetomidine-remifentanil when compared to midozolam-remifentanil. The dexmedetomidine-remifentanil combination affected the cognitive functions less than the midozolam-remifentanil did and the recovery periods were found to be shorter in this group. Besides rates of patient and surgeon satisfaction were found to be superior with dexmedetomidine-remifentanil. It was concluded that, dexmedetomidine-remifentanil is a combination of choice during MAC for short outpatient surgical procedures.