Background: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient\nsedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was\nto compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF)\ncombination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC).\nMethods: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF. All patients\nreceived 1 Ã?¼g.kgâË?â??1 dexmedetomidine over 10 min followed by 0.2ââ?¬â??1.0 Ã?¼g.kgâË?â??1hâË?â??1 in order to maintain 3 or 4 of\nmodified Observer's Assessment of Analgesia and Sedation score checked every 3 min. At the start of dexmedetomidine\ninfusion, patients in group DK or DMF received 0.5 mg.kgâË?â??1 ketamine or 0.05 mg.kgâË?â??1 midazolam+ 0.5 Ã?¼g.kgâË?â??1 fentanyl\nintravenously, respectively. When required, rescue sedatives (0.5 mg.kg-1 of ketamine or 0.05 mg.kg-1 of midazolam)\nand analgesics (0.5 mg.kg-1 of ketamine or 0.5 Ã?¼g.kg-1 of fentanyl) were given to the patients in DK or DMF group,\nrespectively. The primary outcome of this study was the recovery parameters (time to spontaneous eye opening and\nthe length of the recovery room stay). The secondary outcomes were parameters indicating quality of sedation/\nanalgesia, cardiorespiratory variables, and satisfaction scores.\nResults: There were no significant differences in the onset time, time to spontaneous eye opening, recovery room\nstay, the incidences of inadequate analgesia, hypotension and bradycardia between the two groups. Despite lower\ninfusion rate of dexmedetomidine, more patients in the DMF group had bispectral index (BIS) < 60 than in the DK\ngroup and vice versa for need of rescue sedatives. The satisfaction scores of patients, surgeon, and anesthesiologist in\nthe DMF group were significantly better than the DK group.\nConclusions: The DK and DMF groups showed comparable recovery time, onset time, cardiorespiratory variables, and\nanalgesia. However, the DMF group showed a better sedation quality and satisfaction scores despite the lower infusion\nrate of dexmedetomidine, and a higher incidence of BIS < 60 than the DK group.
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