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Objective: To compare dexmedetomidine and midazolam for effective sedation and pain relief during monitored anesthesia care for septoplasty using ramsay sedation scale and visual analogue scale. Study Design: Prospective observational study. Place and Duration of Study: Anesthesia Department, Combined Military Hospital Malir, from May 2019 to Jul 2019. Methodology: After ethical committee approval, 100 patients were recruited and divided in two groups to undergo septoplasty under local anesthesia. Group1 received dexmedetomidine 1 microgram/kg intravenously given over Five minute followed by 0.5 micrograms/kg/hr. Group 2 received midazolam 0.06 mg/kg intra-venously slowly followed by 0.01mg/kg/hr. Sedation was titrated with ramsay sedation scale. The target end point was patient having ramsay sedation scale 3 by the end of 10 minutes. Rescue sedation was given in patients having ramsay sedation scale <3. Intraoperative pain was assessed using visual analogue scale. Visual analogue scale target value was <6. Rescue analgesia was given if visual analogue scale >5. Results: Mean ramsay sedation scale was significantly high in group-1 (2.6 ± 0.48) as compared to group-2 (2.18 ± 0.54) with a p-value of 0.008. Intra-operative rescue sedation was provided in significantly less number of patients in group-1 18 (36%) as compared to group-2 35 (70%) with a p-value of 0.009. Visual analogue scale was also significantly less in group-1 (2.4 ± 1.4) than in group-2 (3.2 ± 1.6) with a p-value of 0.017. Intra-operative rescue analgesia was also required in significantly lesser number of patients in group-1 13 (26%) than group-2 27 (54%) with a p-value of 0.007. Conclusion: This study proved that dexmedetomidine is superior to midazolam for providing sedation and analgesia.

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