• Sunil Rajan, Rittick Talukdar, Pulak Tosh, Jerry Paul, Bindu K Vasu, and Lakshmi Kumar.
• Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
• Anesth Essays Res. 2018 Jan 1; 12 (1): 11-15.

BackgroundAwake fiberoptic intubation (AFOI) is the gold standard for the management of predicted difficult airway, and inappropriate sedation is a major cause leading to its failure.AimsThe primary objective was to compare the heart rate (HR) changes that accompany AFOI following sedation with dexmedetomidine and fentanyl. Secondary objectives included comparison of changes in blood pressure, patient comfort, ease of intubation, and degree of sedation.Settings And DesignsThis prospective double-blinded randomized study was conducted in a tertiary care institution.Subjects And MethodsForty patients with anticipated difficult airway requiring AFOI were included in the study. Group A received dexmedetomidine 1 μg/kg whereas Group B received fentanyl 2 μg/kg. After topical anesthesia of the airway, AFOI was performed.Statistical Analysis UsedFisher's exact test, independent two-sample t-test, and Mann-Whitney U-test were used as applicable.ResultsThe hemodynamic parameters were comparable in both the groups except at 1 min postintubation when fentanyl group had significantly higher HR. There were lower alertness and muscle tone scores in dexmedetomidine group. Total comfort score was significantly higher in fentanyl group. Though more patients in dexmedetomidine group showed that no reaction to intubation and more patients in fentanyl had slight grimacing, the difference was insignificant. The ease of intubation was similar in both the groups.ConclusionThough dexmedetomidine1 μg/kg and fentanyl 2 μg/kg premedication results in comparable hemodynamics and ease of intubation, in view of enhanced patient comfort, dexmedetomidine premedication is advantageous in patients with anticipated difficult airway undergoing AFOI.

7 keywords...

hide…