Dexmedetomidine Continuous Infusion vs. Remifentanil Target-Controlled Infusion for Conscious Sedation in Otosclerosis Surgery—A Prospective, Single-Center, Randomized Controlled Trial

<b>Background/Objectives:</b> Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient's quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, with the latter enabling real-time assessment of hearing improvement while providing optimal surgical conditions and patient satisfaction. This study examines the efficacy and safety of continuous dexmedetomidine infusion and target-controlled remifentanil infusion for conscious sedation combined with local anesthesia in otosclerosis surgery. <b>Methods:</b> Seventy-four adult patients undergoing otosclerosis surgery were randomly assigned to either the dexmedetomidine group or the remifentanil group. Primary outcomes included patient satisfaction at 24 h post-surgery and surgeon satisfaction with operative conditions. Secondary outcomes comprised hemodynamic effects, the necessity for adjuncts to the proposed sedation protocols, and intra- and postoperative complications. <b>Results:</b> There was no statistically significant difference between the dexmedetomidine and remifentanil groups regarding patient satisfaction (<i>p</i> = 0.943) and surgeon satisfaction (<i>p</i> = 0.069). A strong correlation was observed between surgeons' assessments and patients' satisfaction Composite Scores (η² = 0.185, <i>p</i> = 0.003). Dexmedetomidine was more effective in significantly reducing arterial pressure and heart rate without undesirable clinical effects. <b>Conclusions</b>: No significant difference was found between the groups concerning patient and surgeon satisfaction. Dexmedetomidine infusion led to considerable reductions in arterial pressure and heart rate compared to remifentanil.