Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: A Prospective Randomized Study

Eun Hee Chun, Myeong Jae Han, Hee Jung Baik, Hahck Soo Park, Rack Kyung Chung, Jong In Han, Hun Jung Lee, Jong Hak Kim

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14 Scopus citations


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

Original languageEnglish
Article number49
JournalBMC Anesthesiology
Issue number1
StatePublished - 2 Aug 2016

Bibliographical note

Publisher Copyright:
© 2016 Chun et al.


  • Dexmedetomidine
  • Fentanyl
  • Ketamine
  • Midazolam
  • Monitored anesthesia care


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