AIM • To assess the safety profile of the drug in External DCR with respect to blood pressure(BP), heart rate(HR) and oxygen saturation rate . • To study the efficacy of the drug in terms of intraoperative analgesia and surgeons comfort

MATERIALS AND METHODS

This is a prospective interventional study done in 64 patients who had undergone External DCR during the time period from October 2012 to May 2014.Patients <18 yrs were excluded .The drug was given based on the body weight. An initial loading dose of 1µg/kg was given over a period of 10 minutes. This was followed by a maintenance infusion of 0.2-1µg/kg/hr during the time of surgery. The local infiltration in the form of infraorbital and infratrochlear nerve block was given in all cases .The dose adjusted depending on the hemodynamic variables as well as the sedative effect of the drug.Heart Rate, Blood Pressure, O2 Saturation monitored continuously. Intraoperative sedation, Intraoperative pain and surgeons comfort assessed. The sedation level was assessed using Ramsay sedation score (RSS). The degree of pain was assessed by using a 10-cm visual analog scale for pain where: 0=no pain and 10=intolerable pain at incision,bone punching and closure of the wound.The surgeon satisfaction was recorded using a four point scale as Excellent ,Good ,Fair and Poor . Intraoperative and immediate post operative complications were recorded.

RESULTS There were 16 males and 48 females .Three patients underwent bilateral DCR in the same sitting.All the patients had reduction in BP ranging from 60 mm of Hg to 10 mm of Hg in case of Systolic BP and Diastolic BP reduced from 30 mm of Hg to 4 mm of Hg. 78 % of study group maintained a sedation score of RSS 4 during the surgery . One patient had a score of 1 and she needed additional analgesic to proceed with the surgery. 84% of patients had a pain score of 0 all through out the surgery whereas 15% needed additional local infiltration during bone punching step of surgery. Surgeon satisfaction was excellent in 82% of cases and good in 15% of cases. One patient had vomiting in the perioperative period which subsided with antiemetics.

CONCLUSION Dexmedetomidine is a safe and efficient adjunct to the nerve blocks in Dacryocystorhinostomy . The complications and the risk of GA can be avoided with the use of this drug without compromising the surgeon satisfaction and patient comfort.