A Clinical Comparative Study of Total Intravenous Anaesthesia with Propofol-Fentanyl Versus Dexmedetomidine-Fentanyl for Tympanoplasty Surgery in Adults

Narendra Babu M.C, Rosalyn Fiona Cyril, Manoj S
Author(s)
1Professor and Head, Department of Anaesthesiology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. 2Associate Professor, Department of Anaesthesiology, Dr. BS Tomar Institute of Medical Sciences, Jaipur, Rajasthan, India. 3Associate Professor, Department of Anaesthesiology, Viraat Ramayan Institute of Medical Sciences, East Champaran, Bihar, India

Abstract

Background: Total intravenous anaesthesia (TIVA) avoids the drawbacks of inhalational agents and nitrous oxide. Propofol enables rapid induction and recovery, while dexmedetomidine offers sedation, analgesia, and hemodynamic stability without respiratory depression. This study compares the efficacy and hemodynamic effects of dexmedetomidine versus propofol in patients undergoing tympanoplasty under TIVA. The study aimed to evaluate dexmedetomidine as a TIVA agent for tympanoplasty surgeries compared to propofol. It focused on comparing induction and recovery characteristics, analgesic properties, cardiovascular effects, and adverse events associated with both agents. Material and Methods: This randomized controlled trial, conducted at Kempegowda Institute of Medical Sciences from December 2014 to April 2016, compared total intravenous anaesthesia using Propofol-Fentanyl (Group P) versus Dexmedetomidine-Fentanyl (Group D) in 60 ASA I and II patients aged 18–60 undergoing tympanoplasty under 60 minutes. Patients were randomized via sealed envelopes. Group P received propofol 2 mg/kg induction and 6 mg/kg/hr infusion; Group D received dexmedetomidine 1 µg/kg over 10 minutes, then 0.6 µg/kg/hr. Both groups received fentanyl at 0.5 µg/kg/hr. Results: Propofol enabled faster induction (29.67±1.81 sec) than dexmedetomidine (583.97±59.16 sec), while dexmedetomidine provided better analgesia. Both agents maintained hemodynamic stability despite reducing SBP, DBP, MAP, and HR. Recovery was quicker with dexmedetomidine (6.70±1.09 min) versus propofol (7.93±1.39 min), but PACU discharge was faster with propofol (25.67±4.69 min vs 45.67±5.37 min). Conclusion: Dexmedetomidine offers effective sedation, analgesia, and stable hemodynamics, making it a suitable alternative to propofol for total intravenous anaesthesia.

Keywords: Propofol, Dexmedetomidine, Total Intravenous Anaesthesia (TIVA).

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