A comparison of the effectiveness of dexmedetomidine versus propofol-fentanyl combination for sedation during awake fibreoptic nasotracheal intubation
Indian Journal of Clinical Anaesthesia
In patients with anticipated difficult airway, awake fiber optic intubation (AFOI) is an established modality. Various drugs have been used to provide favourable intubating conditions with good patient comfort and cooperation. Commonly used agents are opioids and benzodiazepines along with the recent agents like dexmedetomidine. We undertook this study to compare dexmedetomidine against propofol-fentanyl combination for AFOI. Materials and Methods: A randomized prospective study was performed
... sixty patients with anticipated difficult airway and allocated into two groups each containing thirty. Propofol-fentanyl (PF) group received initial bolus of inj propofol 0.5 mg/kg and fentanyl 0.5μg/kg followed by propofol infusion of 30µg/kg/min and dexmedetomidine (DEX) group received loading dose of 1µg/kg for 10 min and followed by maintenance infusion of 0.5μg/kg/h. We analyzed haemodynamics, saturation, Ramsay sedation score, rescue midazolam requirement, airway obstruction, patient tolerance and intubating conditions. Results: There was no difference in demographic variables between the two groups. PF group achieved higher mean Ramsay sedation score (RSS) during AFOI as compared to DEX group, (P<0.05). PF group (76.7%) had more favourable cough scores (≤2) as compared to DEX group (40%) (p<0.05). Both the groups had comparable vocal cord movement and limb movement scores. Favorable patient tolerance scores were achieved in twenty-four patients (80%) in PF group in comparison to eighteen patients (60%) in DEX group (P<0.05). Twentythree (76.7%) in DEX group had patent airway (score 1) compared to twelve patients (40%) in PF group (P<0.05). Conclusion: Both PF and DEX provided comparable satisfactory intubating conditions for AFOI in terms of vocal cord and limb movement scores. However, PF combination provided lower cough scores and better patient tolerance scores. Dexmedetomidine offered better patent airway with spontaneous ventilation. Reduced hemodynamic response to intubation was achieved in both the groups, although PF group caused more hypotension during AFOI. No episodes of hypoxia was seen in both the groups.