A prospective randomized double blind study to compare the effects of dexmedetomidine and fentanyl on intubating conditions during awake fiberoptic bronchoscopy guided intubation Patodi Veena1, Upreti Bhawesh2, Sethi Surendra K.3,*, Jain Neena4, Gurjar Satveer S.3 1Senior Professor, Dept. of Anaesthesia, JLN Medical College and Hospital, Ajmer, Rajasthan, India 2Junior Resident, Dept. of Anaesthesia, JLN Medical College and Hospital, Ajmer, Rajasthan, India 3Assistant Professor, Dept. of Anaesthesia, JLN Medical College and Hospital, Ajmer, Rajasthan, India 4Senior Professor and Head, Dept. of Anaesthesia, JLN Medical College and Hospital, Ajmer, Rajasthan, India *Corresponding Author: Email: drsurendrasethi80@gmail.com
Online published on 3 January, 2019. Abstract Introduction Various drugs have been used for sedation to provide adequate intubating conditions during awake fiberoptic intubation (AFOI) but these drugs may cause excessive sedation followed by respiratory depression which is undesirable in these patients. So this study was planned with aim to compare dexmedetomidine with fentanyl for conscious sedation during AFOI in adult patients posted for various elective surgical procedures under general anaesthesia. Materials and Methods Sixty adult patients were randomly allocated into two groups with 30 patients each. After pre operative evaluation and informed consent, patients were given pre anaesthetic medication followed by airway nerve blocks. Group A (n=30); Dexmedetomidine Group received intravenous (IV) dexmedetomidine 1.5 μg/kg diluted in 100 ml normal saline (NS) over 10 min and Group B (n=30); Fentanyl Group received IV fentanyl 2 μg/kg diluted in 100 ml NS over 10 min. After achieving adequate sedation (RSS ≥ 2), awake fiberoptic bronchoscopy and intubation was done. Intubating conditions, oxygen desaturation caused, tolerance to intubation and haemodynamic changes along with adverse effects were observed and noted in both groups. Results Cough score and intubation comfort scores were significantly better in Group A when compared to Group B. (P <0.05) The patients in Group A showed less oxygen desaturation as compared to Group B that was statistically significant. (P < 0.05) Post intubation score was also found to be significantly better in Group A. (P <0.05) However, no significant haemodynamic changes and adverse effects were noted in patients of Group A (P >0.05). Conclusion Dexmedetomidine (1.5 μg/kg) is preferable over fentanyl (2 μg/kg) for conscious sedation during AFOI as it provides more favourable intubating conditions with minimal haemodynamic changes and adverse effects. Top Keywords Awake fiberoptic intubation, Conscious sedation, Dexmedetomidine, Intubating conditions, Fentanyl, Oxygen desaturation. Top |