Background: Monitored anaesthesia care (MAC) has become increasingly used for middle ear surgeries which usually combines a local anaesthetic agent with intravenous sedation. Dexmedetomidine has gained popularity for intravenous sedation for the procedures to be done under  MAC. So this study was aimed at to compare the efficacy of dexmedetomidine with midazolam  for sedation, analgesia, patient and surgeon satisfaction along with various haemodynamic changes and side effects.

Methods: Eighty adult patients of either sex aged 18–60 years with ASA grade І and ІІ undergoing tympanoplasty and modified radical mastoidectomy under MAC were randomly allocated into two groups. Group D (n = 40) received intravenous dexmedetomidine 1 μg/kg diluted up to 30 ml by normal saline given over 15 min followed by a continuous infusion of 0.5 μg/kg/h and  Group M (n = 40) received intravenous midazolam 0.05 mg/kg diluted up to 30 ml normal saline  given over 15 min followed by continuous infusion of 0.01 mg/kg/h.  Ramsay sedation score (RSS), Visual analogue score (VAS), rescue sedative and analgesic requirement, patient and surgeon satisfaction scores ,haemodynamic parameters and side effects were recorded and compared in both groups. The data were analysed using different statistical tests.

Results: The mean RSS was significantly more in Group D (3.0±0.0) as compared to Group M (2.85±0362),(P<0.05).The mean VAS was significantly lesser in Group D in comparison to Group M,(P<0.05).The total number of patients and number of doses of rescue sedative required  were significantly lesser in Group D [12(30%),0.3±0.464)] as compared to Group M [36(90%),1.3±0.648],(P<0.05).Similarly, the total number of patients and number of doses of rescue analgesic were significantly lesser in Group D [4(10%),0.10±0.308] as compared to Group M [14(35%),0.38±0.540],(P<0.05). The patient and surgeon satisfaction scores were significantly better in Group D,(P<0.05).The HR was reduced significantly in Group D,P<0.05, while SBP and DBP remained comparable to their respective baseline values in both groups,(P<0.05). In Group D, four patients had experienced bradycardia.

Conclusion: Dexmedetomidine could be a safer and effective alternative to midazolam for tympanoplasty and modified radical mastoidectomy done under monitored anaesthesia care.