Sujata Panda1 , Choubarga Naik2 , Rajiv Nanda3 , Bimal Krushna Panda4
BACKGROUND Tympanoplasty is a common surgery done for the repair of perforated tympanic membrane in case of inactive mucosal Chronic Suppurative Otitis Media (CSOM). This procedure is performed under both local and general anaesthesia, both having their own advantages and disadvantages. The advantages of local anaesthesia in tympanoplasty are, the ability to test hearing during surgery, faster recovery time and less bleeding. But the common disadvantages of local anaesthesia were anxiety, noise during surgery, backache, claustrophobia and earache. These can be eliminated by providing sedation to patient or by administering general anaesthesia. METHODS Eighty patients of either sex, aged between 18 and 50 years, of ASA Grades I and II, undergoing tympanoplasty under local anaesthesia or general anaesthesia were included. Patients in Local Anaesthesia group received a bolus dose of injection dexmedetomidine 1 μg / Kg IV over 10 min followed by an infusion started at 0.4 μg / Kg / h I.V. Patients of General Anaesthesia group received inj. propofol 1 mg / Kg, followed by 1 mg / Kg of vecuronium bromide. After 2 minutes patients were put on LMA and maintained with oxygen and nitrous oxide in the ratio of 1 : 1 and 0.5 mac of isoflurane throughout the procedure and were switched off on the commencement of skin stitch. RESULTS A total of 80 patients were enrolled and were equally divided in to two groups. Males were predominant in both groups. 9 patients had slight bleeding requiring suctioning in group A. 17 in group B which had more than slight bleeding and 2 out of them required frequent suctioning. In 22 cases of group A surgeon had excellent satisfaction whereas it was 18 cases in group B. Group B experienced more complications then group A. Nausea and vomiting were present in 7 cases of group B whereas it was 3 cases of group A. CONCLUSIONS Local anaesthetic technique with sedation has an edge over general anaesthesia technique with LMA being preferred by the surgeon, and the haemodynamic milieu was better managed with fewer complications.
