Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study
- PMID: 25948903
- PMCID: PMC4411836
- DOI: 10.4103/0970-9185.155151
Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study
Abstract
Background and aims: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI.
Material and methods: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups.
Results: Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B.
Conclusion: Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI.
Keywords: Awake intubation; dexmedetomidine hydrochloride; fentanyl citrate.
Conflict of interest statement
Similar articles
-
Evaluation of Effectiveness of Dexmedetomidine and Fentanyl-midazolam Combination on Sedation and Safety during Awake Fiberoptic Intubation: A Randomized Comparative Study.Anesth Essays Res. 2017 Oct-Dec;11(4):998-1003. doi: 10.4103/aer.AER_150_17. Anesth Essays Res. 2017. PMID: 29284863 Free PMC article.
-
Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial.Braz J Anesthesiol. 2021 May-Jun;71(3):259-264. doi: 10.1016/j.bjane.2021.01.005. Epub 2021 Mar 17. Braz J Anesthesiol. 2021. PMID: 33744331 Free PMC article. Clinical Trial.
-
A Comparative Study of Midazolam Alone or in Combination with Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation.Anesth Essays Res. 2019 Jul-Sep;13(3):539-546. doi: 10.4103/aer.AER_64_19. Anesth Essays Res. 2019. PMID: 31602075 Free PMC article.
-
A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation.Medicine (Baltimore). 2021 Apr 9;100(14):e25324. doi: 10.1097/MD.0000000000025324. Medicine (Baltimore). 2021. PMID: 33832107 Free PMC article.
-
Awake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials.Anesth Analg. 2019 May;128(5):971-980. doi: 10.1213/ANE.0000000000004087. Anesth Analg. 2019. PMID: 30896601
Cited by
-
Hemodynamic Responses and Safety of Sedation Following Premedication with Dexmedetomidine and Fentanyl during Fiberoptic-assisted Intubation in Patients with Predicted Difficult Airway.Anesth Essays Res. 2018 Jan-Mar;12(1):11-15. doi: 10.4103/aer.AER_176_17. Anesth Essays Res. 2018. PMID: 29628546 Free PMC article.
-
The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial.Front Pharmacol. 2016 Nov 3;7:410. doi: 10.3389/fphar.2016.00410. eCollection 2016. Front Pharmacol. 2016. PMID: 27857689 Free PMC article.
-
Intravenous dexmedetomidine as an adjunct to subarachnoid block: A simple effective method of better perioperative efficacy.J Anaesthesiol Clin Pharmacol. 2017 Apr-Jun;33(2):203-208. doi: 10.4103/joacp.JOACP_367_15. J Anaesthesiol Clin Pharmacol. 2017. PMID: 28781446 Free PMC article.
-
Dexmedetomidine vs. midazolam-ketamine for sedation during awake fiberoptic nasal intubation in patients with difficult airway - A randomized, double-blinded, comparative trial.J Anaesthesiol Clin Pharmacol. 2025 Jul-Sep;41(3):496-502. doi: 10.4103/joacp.joacp_247_24. Epub 2025 May 9. J Anaesthesiol Clin Pharmacol. 2025. PMID: 40635813 Free PMC article.
-
Is It Time for an Expanded Role of Dexmedetomidine in Contemporary Anesthesia Practice? - A Clinician's Perspective.Transl Perioper Pain Med. 2018;5(3):55-62. Epub 2018 Apr 12. Transl Perioper Pain Med. 2018. PMID: 31595218 Free PMC article.
References
-
- Rosenblatt WH. Airway management. In: Barash PG, Cullen BF, Stoelting RK, et al., editors. Clinical Anesthesia. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. pp. 595–638.
-
- Bergese SD, Khabiri B, Roberts WD, Howie MB, McSweeney TD, Gerhardt MA. Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases. J Clin Anesth. 2007;19:141–4. - PubMed
-
- Lallo A, Billard V, Bourgain JL. A comparison of propofol and remifentanil target-controlled infusions to facilitate fiberoptic nasotracheal intubation. Anesth Analg. 2009;108:852–7. - PubMed
-
- Rai MR, Parry TM, Dombrovskis A, Warner OJ. Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: A double-blinded randomized controlled trial. Br J Anaesth. 2008;100:125–30. - PubMed
-
- Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology. 1990;73:826–30. - PubMed
LinkOut - more resources
Full Text Sources
Other Literature Sources