Comparison of dexmedetomidine and sufentanil for conscious sedation in patients undergoing awake fibreoptic nasotracheal intubation: a prospective, randomised and controlled clinical trial

Abstract

Introduction: Fibreoptic intubation is a valuable technique for difficult airway management in which conscious sedation is paramount.

Objectives: To investigate the efficacy and safety of dexmedetomidine (DEX) and sufentanil (SUF) for conscious sedation during awake nasotracheal intubation under vision by a fibreoptic bronchoscope.

Methods: Forty patients with anticipated difficult airways of American Society of Anesthesiologists I-II scheduled for awake fibreoptic nasotracheal intubation were randomised into two groups each containing 20 subjects. DEX group received DEX at a dose of 1.0 μg/kg over 10 min followed by a continuous infusion of 0.5 μg/kg per hour, while SUF group received SUF target controlled infusion in which the target plasma concentration was 0.3 ng/mL. The nasotracheal intubation conditions and the tolerance to nasotracheal intubation were observed; the occurrence of adverse events including hypertension, bradycardia and respiratory depression during nasotracheal intubation and post-surgical throat pain and hoarseness, and post-surgical memory score were recorded.

Results: Better nasotracheal intubation conditions and higher tolerance to intubation were observed in DEX group than those in SUF group (P < 0.05). The incidence rates of hypertension, respiratory depression during intubation and throat pain after surgery were lower in DEX group than those in SUF group; however, the incidence of bradycardia was higher in DEX group than that in SUF group.

Conclusions: DEX provides better nasotracheal intubation conditions, improves patients' tolerance to intubation and leads to lower occurrence of hypertension, respiratory depression and throat pain and post-surgical memory score for sedation during awake fibreoptic nasotracheal intubation.

Keywords: awake nasotracheal intubation; dexmedetomidine; fibreoptic bronchoscope; sedation; sufentanil.