A Comparative Study between Dexmedetomidine versus Fentanyl on Intubating Conditions and Side Effects during Awake Fiberoptic Nasal Intubation under Topical Anesthesia in Patients Underwent Elective Surgical Operation

摘要

Awake fiber optic intubation is the gold standard technique for management of anticipated difficult airway. In spite of availability of several sedatives, at higher doses these drugs cause respiratory depression and sensorium. This study was conducted to evaluate and compare the efficacy of Dexmedetomidine or Fentanyl for sedation during AFOI. Sixty patients, aged 20 - 40 years undergoing AFOI were made into two groups, group D Dexmedetomidine 1 mcg/kg, and group F Fentanyl 2 μg/kg, both drugs was diluted with 50 ml saline to be infused over 10 minutes). Demographic data, patient cough score, sedation score and post-intubation score were compared between two groups. Cough score ≤ 2 was 25 patients in group D compared with 2 patients in group F, post intubation score 1 in group D was 24 vs. 2 in group F, mean Ramsy sedation score in group D was 3 vs. 2.1 in group F, SpO2 ≥ 95% in group D was 28 vs. 5 patients in group F, insignificant rise in MAP from 93 to 96 mmhg in group D (P = 0.347), but there was significant rise from 92.3 to 118.18 (P ≤ 0.0001) in group F, there was significant decrease in HR from 77.4 to 71 (P = 0.005) vs. significant rise from 77 to 114 (P ≤ 0.0001) in group F. Thus, we can conclude that Dexmedetomidine provides better intubating condition, sedation, less respiratory depression and hemodynamic stability than fentanyl for AFOI, without adversely affecting airway.