A Comparative Study between Local Dexmedetomidine and Intravenous Dexmedetomidine during Awake Fiberoptic Nasotracheal Intubation

Abstract

Background: Awake fiberoptic intubation (AFOI) is the gold standard for managing a difficult airway. To make the patient comfortable and cooperative during the procedure, many drugs such as benzodiazepines, opioids, or dexmedetomidine are used. Most of these intravenously given drugs may cause respiratory depression and hypoxia. Aim: We compared the efficacy of dexmedetomidine through nebulization and transtracheal route with intravenous routes with the primary aim of comparing patient tolerance score (PTS) and secondary objectives of comparing sedation score, cough score, and total duration required for awake fiberoptic nasotracheal intubation. Settings and Design: This study was a prospective randomized double-blind study. Subjects and Methods: Seventy-six patients, scheduled for elective surgery requiring AFOI between 18 and 75 years, were included in the study. They were randomly divided into two groups of 38 each. Group I patients received intravenous dexmedetomidine 1 μg.kg −1 and Group L patients received local dexmedetomidine through nebulization 0.5 μg.kg −1 and transtracheal injection 0.5 μg.kg −1 . Statistical Analysis Used: Statistical Package for the Social Sciences version 22 was used. Results: Patients who received dexmedetomidine through nebulization and transtracheal route have significantly better PTSs and less cough scores as compared to patients who received dexmedetomidine by intravenous route ( P < 0.05). Hemodynamic parameters and sedation scores between the two groups were statistically insignificant ( P > 0.05). The time required for the procedure was significantly less in Group L compared to Group I ( P < 0.05). Conclusion: Dexmedetomidine by nebulization and transtracheal route provides optimal conditions for AFOI with good patient tolerance and less cough score as compared to the intravenous route.

A Randomized Comparison of Intravenous Versus Nebulized Routes for Administering Dexmedetomidine and Ketamine Combination to Facilitate Awake Fibreoptic Intubation

“…Furthermore, as ketamine and dexmedetomidine do not have a local anesthetic or analgesic action, nebulization did not have any effect other than the effect due to systemic absorption of the drugs through respiratory mucosa. Similarly, the cough severity, patient tolerance, intubating conditions, propofol requirement, and hemodynamic variables were better in group I than in group N. The trial findings of Sancheti et al contradict the findings of our study [ 12 ]. This may be because the authors used an additional (transtracheal) route of dexmedetomidine administration in their study.…”

“…Intravenous dexmedetomidine was found to suppress the response to laryngoscopy and intubation better than nebulized dexmedetomidine. Sancheti et al compared the intravenous route of dexmedetomidine with a combination of nebulized and transtracheal injections of dexmedetomidine [ 12 ]. They found that dexmedetomidine delivered using a combination of nebulized and transtracheal routes had better patient satisfaction than the intravenous route.…”

Nebulised/aerosolised drugs in anaesthesiology, critical care and pain practice–benefit with a professional hazard!

“…This modality is increasingly being used in anaesthesiology, critical care and pain practice to deliver drugs like antibiotics, dexmedetomidine, lidocaine, morphine and fentanyl. [ 1 2 3 4 5 6 7 8 9 10 11 12 ] This journal has published many manuscripts about using these drugs in the perioperative period for quoted beneficial effects. [ 2 3 4 5 6 7 8 9 10 11 ]…”