Comparative Evaluation of Intravenous Midazolam and Dexmedetomidine on Sedation Quality and Hemodynamic Stability in Abdominal Hysterectomy with Spinal Anesthesia

Background: Spinal anesthesia is widely preferred for lower abdominal surgeries due to its rapid onset, dense neural block, and minimal systemic effects.Sedation and stable hemodynamics are critical to patient comfort and safety during surgery.Adjuvants like midazolam and dexmedetomidine are commonly administered intravenously to enhance sedation while maintaining hemodynamic stability.Objective: To compare the sedation quality and hemodynamic effects of intravenous midazolam and dexmedetomidine in patients undergoing abdominal hysterectomy under spinal anesthesia.Methods: A prospective, single-blind, randomized controlled study was conducted on 150 patients [American Society of Anesthesiologists (ASA) I-II] undergoing abdominal hysterectomy.Patients were randomly assigned to group D (dexmedetomidine 1 µg/kg IV) or group M (midazolam 0.05 mg/kg IV), administered over 10 minutes.Sedation was assessed using the Ramsay Sedation Score (RSS), while hemodynamic parameters [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), and SpO₂] were monitored at 0, 15, 30, 45, 60, 75, and 90 minutes.Results: Baseline demographic and hemodynamic characteristics were comparable between groups.After 45 minutes, mean RSS was significantly higher in group D compared with group M (p < 0.05), indicating deeper sedation.Heart rate, blood pressure, RR, and SpO₂ remained stable and comparable between groups throughout the procedure (p > 0.05).No significant adverse hemodynamic events were observed.Conclusion: Intravenous dexmedetomidine provides superior sedation quality compared with midazolam while maintaining stable hemodynamics during abdominal hysterectomy under spinal anesthesia.Dexmedetomidine is a preferable adjuvant for achieving optimal intraoperative sedation without compromising patient safety.