Uppaluri Sarat Chandra, Kumar Anne Kiran, Kumar G Suneel, Nizami Mohammed Ismail, Sharma Ashima
Department of Emergency Medicine, AIG Hospitals, Hyderabad, Telangana, India.
Department of Anaesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Turk J Emerg Med. 2025 Apr 1;25(2):116-122. doi: 10.4103/tjem.tjem_175_24. eCollection 2025 Apr-Jun.
Effective sedation and analgesia during procedures not only provide relief of suffering but also frequently facilitate the successful and timely completion of the procedure. The aim of the study was to evaluate the efficacy of fentanyl and dexmedetomidine compared to fentanyl and midazolam in procedural sedation for tube thoracostomy in the emergency department (ED) in terms of analgesia and patient satisfaction with sedation during the procedure using Pain Numerical Rating Scale and a 7-point Likert-like verbal rating scale for comfort rating of sedation.
A randomized control study was conducted in 64 subjects admitted to the ED. Tube thoracostomy was performed in patients after the decision for Intercostal drain (ICD) placement taken on radiographic and clinical assessment depending on their condition warranting it and after optimally stabilizing the patient in the ED. Of the total study participants that met the inclusion criteria, 32 participants randomly received dexmedetomidine and the other 32 received midazolam.
Pain rating scale means were 2.3 ± 1.12 and 4.4 ± 1.72, respectively ( < 0.001), in dexmedetomidine and midazolam groups. With regard to adverse effects, a statistically significant difference was seen with dexmedetomidine causing hypotension ( = 0.04) and midazolam causing desaturation ( = 0.008). The results also suggested that midazolam achieved sedation levels quicker than dexmedetomidine and this finding was statistically significant ( < 0.001). A statistically significant difference was observed ( < 0.001) with regard to mean patient verbal ratings at recovery of sedation satisfaction between the two groups, 6 ± 0.77 (dexmedetomidine group) versus 4.7 ± 0.8 (midazolam group).
When observed in terms of analgesia, anxiolysis, and better sedation, dexmedetomidine proved to be superior. Our study shows that this drug could be a better alternative to traditional benzodiazepines for procedural sedation in ED.
在操作过程中有效的镇静和镇痛不仅能减轻痛苦，还常常有助于操作成功且及时完成。本研究的目的是比较在急诊科（ED）行胸腔闭式引流术时，芬太尼联合右美托咪定与芬太尼联合咪达唑仑在程序镇静方面的镇痛效果以及患者对镇静的满意度，使用疼痛数字评定量表和7点李克特式言语评定量表对镇静舒适度进行评分。
对64例入住急诊科的患者进行随机对照研究。根据患者的病情及影像学和临床评估决定行肋间引流（ICD）置管后，在急诊科对患者进行最佳稳定处理后为其实施胸腔闭式引流术。在符合纳入标准的全部研究参与者中，32例参与者随机接受右美托咪定，另外32例接受咪达唑仑。
右美托咪定组和咪达唑仑组的疼痛评定量表平均值分别为2.3±1.12和4.4±1.72（<0.001）。在不良反应方面，右美托咪定导致低血压（=0.04），咪达唑仑导致血氧饱和度下降（=0.008），差异有统计学意义。结果还表明，咪达唑仑比右美托咪定更快达到镇静水平，这一发现具有统计学意义（<0.001）。两组患者镇静恢复时的平均言语评分存在统计学差异（<0.001），右美托咪定组为6±0.77，咪达唑仑组为4.7±0.8。
在镇痛、抗焦虑和更好的镇静方面，右美托咪定被证明更具优势。我们的研究表明，在急诊科程序镇静中，这种药物可能是传统苯二氮䓬类药物的更好替代品。
