مقایسه تأثیر سداتیو مخلوط‌های پروپوفول- فنتانیل و پروپوفول– میدازولام برای ایجاد سدیشن در اعمال میکرولانژیال

Abstract Background: Complete regional anesthesia of larynx accompanied by sedation is used for microlaryngeal procedures performed in the vicinity of airway system. In this study we have compared the sedative effects of two combinations of sedative drugs during microlaryngoscopic surgery. Methods: 40 patients who were candidates for microlaryngoscopic surgeries were selected for this study. All patients were in ASA class I-II. At first Laryngeal anesthesia was given by using Lidocaine as superior Laryngeal block and scattering lidocaine as spray on the tongue and pharynx. Intratracheal block was done for all patients. All 40 patients received 0.5 mg/kg of propofol intravenously as bolus, followed by 50 µg/kg/min as an IV infusion. Patients were then randomly divided into two groups. Group I received 0.03 mg/kg of midazolam intravenously and group II received fentanyl 2 µg/kg intravenously. Blood pressure, heart rate and oxygen saturation of arterial blood was checked in all patients after induction of sedation, one minute after initiating Laryngoscopy and one minute after relieving the Laryngoscope stimulation. Time of complete awareness and recovery and also side effects, such as shivering, nausea and vomiting were evaluated. Results: Induction using Fentanyl and propofol was accompanied by a greater degree of bradycardia as compared to the midazolam group, (p<0.02). In addition, decrease in the level of oxygen saturation during laryngoscopy was more marked in the fentanyl group (P <0.05). During the entire procedure, blood pressure showed fluctuation in both groups but reverted to normal faster after eliminating the stimulation in the midazolam group. (P <0.01) Eye opening and complete awareness were faster in the midazolam group. (P <0.01) Nausea occurred in 2 patients of fentanyl group. Recall about the procedure was present in 50% of fentanyl group and 10% of midazolam group (P < 0.01). Conclusion: Sedating patients by midazolam accompanied by Laryngeal block has faster recovery and less recall and also fewer episodes of arterial oxygen desaturation during micro-laryngoscopic surgical procedures . Keywords: Midazolam, Fentanyl, Sedation, Microlaryngeal surgery, Propofol