A Comparative Study of Midazolam and Propofol for BIS Guided Sedation during Middle Ear Surgery under Local Anesthesia

The study was conducted in 60, ASA grade I & II patients for BIS guided sedation during middle ear surgery under local anesthesia. All patients were Pre medicated with Inj. Fentanyl 2μgm/kg and Glycopyrolate 5μg/kg, 10 minutes before surgery. Local anesthesia was given by the experienced ENT surgeon using lidocaine 2% with adrenaline 1:200,000. Patients were randomly divided into two groups. Group I (Inj. Midazolam 0.1% infusion, 0.15 mg/kg/h) and Group II ( Inj. Propofol 1% infusion ,1.5mg/kg/h ). Continuous infusion of study drug was given with manually controlled variable rate infusion pump. Maintenance was done with 0.1mg/kg/hr (If BIS <60) and 0.2mglkg/hr (If BIS >80) in Group I and 1mg/kg/hr (If BIS <60) and 2mg/kg/hr (If BIS >80) in Group II. The infusion was titrated to the level of conscious sedation (BIS 60-80). Time for onset of sedation (BIS <80) was noted. The sedative infusion was stopped 5 minutes prior to end of surgery. In the immediate postoperative period, time taken to reach BIS >90 was noted as Recovery time. Conclusion: Both Propofol and Midazolam in equisedative infusions can be used safely for sedation in middle ear surgery under local anesthesia. Propofol has the advantage of providing faster onset of sedation, rapid clear headed recovery and lesser postoperative nausea/vomiting. We conclude that, Compared with Midazolam, Propofol appears to be more suitable sedative agent for BIS guided sedation.