A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation

Conscious sedation for awake fibreoptic intubation: a review of the literature

“…Despite hemodynamic effects and intubating conditions being similar between groups, DEX-MDZ patients were significantly calmer and more cooperative during AFOI, and they had fewer adverse reactions during AFOI than the MDZ patients. 43 They were also more satisfied with the AFOI (P \ 0.001) than the midazolam-only patients. In another study by the same group, 105 patients requiring AFOI were randomized to either dexmedetomidine or a ''placebo'' with rescue midazolam as required to achieve a Ramsay sedation score of 2 prior to attempting oral or nasal intubation (mean doses 1.07 mg and 2.85 mg of rescue midazolam in the dexmedetomidine and ''placebo'' groups, respectively).…”

“…The antisialagogue and moderate analgesic properties of dexmedetomidine have been cited as other advantages. 41,42 We identified 19 articles, five RCTs 13,29,43-45 and 14 case reports and case series [46][47][48][49][50][51][52][53][54][55][56][57][58][59] describing the use of dexmedetomidine for AFOI, usually as the sole agent but occasionally in combination with midazolam 43 or ketamine. 60 Although a TCI system for dexmedetomidine has been described for awake intubation, 47 it is generally administered as a slow bolus (usually 1 lgÁkg -1 over 10-20 min) to avoid peak-dose hypertension (which may exacerbate a bradycardia-related fall in cardiac output) followed by an infusion (usually of 0.1-0.7 lgÁkg…”

“…29,[43][44][45] Level 1 evidence for the efficacy and safety of dexmedetomidine for AFOI is provided by five RCTs. Tsai et al randomized 40 patients needing AFOI to either dexmedetomidine (1.0 lgÁkg -1 ) or propofol TCI (effect-site concentration 3.6 lgÁmL -1 ) (see above and Table 2).…”

Fiberoptic Intubation: An Overview and UpdateDiscussion

“…In an older study using volunteers, the combination of midazolam and fentanyl for sedation produced apnea in half of the subjects, with nearly all experiencing hypoxemia (oxyhemoglobin saturation Ͻ 90%). 40 More recent case reports, 41,42 case series, 43,44 and randomized studies 45 46 Still another study of 60 patients undergoing fiberoptic nasotracheal intubation found that remifentanil facilitated better cooperation than propofol in patients and may be safer when spontaneous ventilation is critical. 47 FOI can also be performed under general anesthesia, often in the spontaneously ventilating patient.…”

A randomised comparative study of dexmedetomidine and midazolam for sedation during awake fiberoptic intubation in laproscopic cholecystectomy patients

“…Many agents have been reported to provide sedation for intubation including fentanyl, ketamine, midazolam, remifentanil, propofol, and dexmedetomidine. [1][2][3][4][5] Dexmedetomidine, an α2-adrenoceptor agonist, may be a wondrous drug for use during fiberoptic intubation as it produces sedation and analgesia without concomitant depressing respiratory function. 6,7 Thus, dexmedetomidine possess numerous properties that make it a convenient drug for use in managing patients with difficult airways.…”