Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial
Benzodiazepines are the most commonly used sedatives for the reduction of patient anxiety. However, they have adverse intraoperative effects, especially in obstructive sleep apnea (OSA) patients. This study aimed to compare dexmedetomidine (DEX) and midazolam (MDZ) sedation considering intraoperativ...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/19/5849 |
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| author | Ivan Vuković Božidar Duplančić Benjamin Benzon Zoran Đogaš Ruben Kovač Renata Pecotić |
| author_facet | Ivan Vuković Božidar Duplančić Benjamin Benzon Zoran Đogaš Ruben Kovač Renata Pecotić |
| author_sort | Ivan Vuković |
| collection | DOAJ |
| description | Benzodiazepines are the most commonly used sedatives for the reduction of patient anxiety. However, they have adverse intraoperative effects, especially in obstructive sleep apnea (OSA) patients. This study aimed to compare dexmedetomidine (DEX) and midazolam (MDZ) sedation considering intraoperative complications during transurethral resections of the bladder and prostate regarding the risk for OSA. This study was a blinded randomized clinical trial, which included 115 adult patients with a mean age of 65 undergoing urological procedures. Patients were divided into four groups regarding OSA risk (low to medium and high) and choice of either MDZ or DEX. The doses were titrated to reach a Ramsay sedation scale score of 4/5. The intraoperative complications were recorded. Incidence rates of desaturations (44% vs. 12.7%, <i>p</i> = 0.0001), snoring (76% vs. 49%, <i>p</i> = 0.0008), restlessness (26.7% vs. 1.8%, <i>p</i> = 0.0044), and coughing (42.1% vs. 14.5%, <i>p</i> = 0.0001) were higher in the MDZ group compared with DEX, independently of OSA risk. Having a high risk for OSA increased the incidence rates of desaturation (51.2% vs. 15.7%, <i>p</i> < 0.0001) and snoring (90% vs. 47.1%, <i>p</i> < 0.0001), regardless of the sedative choice. DEX produced fewer intraoperative complications over MDZ during sedation in both low to medium risk and high-risk OSA patients. |
| first_indexed | 2024-03-09T21:33:52Z |
| format | Article |
| id | doaj.art-f85ba78d0a9649ecaf96506d9a438916 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T21:33:52Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f85ba78d0a9649ecaf96506d9a4389162023-11-23T20:49:51ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011119584910.3390/jcm11195849Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled TrialIvan Vuković0Božidar Duplančić1Benjamin Benzon2Zoran Đogaš3Ruben Kovač4Renata Pecotić5Department of Anesthesiology, University Hospital Split, 21000 Split, CroatiaDepartment of Anesthesiology, University Hospital Split, 21000 Split, CroatiaSchool of Medicine, University of Split, 21000 Split, CroatiaSchool of Medicine, University of Split, 21000 Split, CroatiaDepartment of Anesthesiology, University Hospital Split, 21000 Split, CroatiaSchool of Medicine, University of Split, 21000 Split, CroatiaBenzodiazepines are the most commonly used sedatives for the reduction of patient anxiety. However, they have adverse intraoperative effects, especially in obstructive sleep apnea (OSA) patients. This study aimed to compare dexmedetomidine (DEX) and midazolam (MDZ) sedation considering intraoperative complications during transurethral resections of the bladder and prostate regarding the risk for OSA. This study was a blinded randomized clinical trial, which included 115 adult patients with a mean age of 65 undergoing urological procedures. Patients were divided into four groups regarding OSA risk (low to medium and high) and choice of either MDZ or DEX. The doses were titrated to reach a Ramsay sedation scale score of 4/5. The intraoperative complications were recorded. Incidence rates of desaturations (44% vs. 12.7%, <i>p</i> = 0.0001), snoring (76% vs. 49%, <i>p</i> = 0.0008), restlessness (26.7% vs. 1.8%, <i>p</i> = 0.0044), and coughing (42.1% vs. 14.5%, <i>p</i> = 0.0001) were higher in the MDZ group compared with DEX, independently of OSA risk. Having a high risk for OSA increased the incidence rates of desaturation (51.2% vs. 15.7%, <i>p</i> < 0.0001) and snoring (90% vs. 47.1%, <i>p</i> < 0.0001), regardless of the sedative choice. DEX produced fewer intraoperative complications over MDZ during sedation in both low to medium risk and high-risk OSA patients.https://www.mdpi.com/2077-0383/11/19/5849dexmedetomidinemidazolamSTOP BANG questionnaireintraoperative complicationsspinal anesthesiasedation |
| spellingShingle | Ivan Vuković Božidar Duplančić Benjamin Benzon Zoran Đogaš Ruben Kovač Renata Pecotić Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial Journal of Clinical Medicine dexmedetomidine midazolam STOP BANG questionnaire intraoperative complications spinal anesthesia sedation |
| title | Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial |
| title_full | Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial |
| title_fullStr | Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial |
| title_full_unstemmed | Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial |
| title_short | Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial |
| title_sort | midazolam versus dexmedetomidine in patients at risk of obstructive sleep apnea during urology procedures a randomized controlled trial |
| topic | dexmedetomidine midazolam STOP BANG questionnaire intraoperative complications spinal anesthesia sedation |
| url | https://www.mdpi.com/2077-0383/11/19/5849 |
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