Comparative study of intubating conditions and hemodynamic changes during awake fiber-optic intubation using midazolam with fentanyl versus dexmedetomidine in cases of difficult airway
Mayank Sachan1, Nikhil Kumar Singh2, Bhavya Naithani3, Haider Abbas4, Mallikarjun Dube5, Bhavini Naithani6
1 Department of Anaesthesia, Critical Care and Pain, Apollomedics Superspeciality Hospital, Lucknow, Uttar Pradesh, India
2 Department of Anaesthesia, Critical Care and Pain, Mahamana Pandit Madanmohan Malviya Cancer Centre, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
3 Department of Plastic Surgery and Critical Care, King Georges Medical University, Lucknow, Uttar Pradesh, India
4 Department of Anaesthesia, Critical Care and Pain, King Georges Medical University, Lucknow, Uttar Pradesh, India
5 Department of Anaesthesia, Critical Care, Command Hospital Central Command, Lucknow, Uttar Pradesh, India
6 Department of Pharmacology, BRD Medical College, Gorakhpur, Uttar Pradesh, India
Dr. Bhavya Naithani
Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: The aim of the study is to compare intubating conditions and hemodynamic changes during awake fiber-optic intubation (AFOI) using midazolam and fentanyl versus dexmedetomidine in cases of difficult airway.
Materials and Methods: A randomized prospective study was conducted in the department of oral and maxillofacial surgery, with a total of 60 patients, 18–55 years of age, ASA class I–II, of either sex with anticipated difficult airway planned for elective surgery. They were divided into two groups; group I patients received 1 μg/kg of dexmedetomidine and then an infusion of 0.5 to 0.7 μg/kg/hr of dexmedetomidine, whereas group II patients received 1 μg/kg of intra-venous (iv) fentanyl and 0.05 mg/kg of iv midazolam with additional doses of 0.02 mg/kg to achieve a Ramsay Sedation Scale score of ≥2. The ease of placement of the fiber-optic scope and the endotracheal tube and the patient's reaction to placement of the fiber-optic scope were assessed on a scale of 1–4 and were recorded as endoscopist satisfaction score and patient discomfort score, respectively.
Results: The endoscopy time ranged from 2.66 ± 1.00 (group I) to 3.90 ± 0.96 (group II) minutes and was found to be statistically significant (p < 0.05). Also, the patient discomfort score was recorded during endoscopy (1–4) and ranged from 1.3 ± 0.53 (group I) and 2.33 ± 0.66 (group II) and was found to be statistically significant (p value < 0.05). Patients undergoing the procedure who received dexmedetomidine were thus more comfortable than those who received fentanyl and midazolam combination.
Conclusion: Dexmedetomidine provided better intubating conditions, patient tolerance, higher endoscopist satisfaction, and reduced hemodynamic responses compared to fentanyl and midazolam combinations. Also, the major advantage of dexmeditomidine for preservation of airway with a lesser degree of respiratory depression allows for safer use of AFOI in cases of difficult airway.