Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study

Mondal, Sudeshna; Ghosh, Shubhamoy; Bhattacharya, Susmita; Choudhury, Brojen; Mallick, Suchismita; Prasad, Ashok

doi:10.4103/0970-9185.155151

Cited by 49 publications

(59 citation statements)

References 25 publications

(26 reference statements)

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“…In concordance with our study, Mondal et al . [ 17 ] also observed similar changes in hemodynamics in their study. They observed that patients of dexmedetomidine group showed better hemodynamic stability.…”

Section: Discussionsupporting

confidence: 78%

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Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study

et al. 2017

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Background:Awake fiberoptic intubation (AFOI) is a recommended technique for anticipated difficult airway. An ideal regime should provide patient comfort, cooperation, amnesia, hemodynamic stability, and blunt airway reflexes and maintain a patent airway with spontaneous ventilation. The aim of our study was to compare intubation conditions between dexmedetomidine and fentanyl–midazolam combination during AFOI.Methods:This prospective, randomized study was conducted on a total of sixty patients of the American Society of Anesthesiologists physical status I and II of either sex, in the age group of 18–60 years having predicted difficult intubation undergoing elective surgeries and the patients were allocated to two groups of thirty patients each. After premedication and topicalization of airways, dexmedetomidine group (Group I, n = 30) received dexmedetomidine 1 μg/kg over 10 min and midazolam–fentanyl group (Group II, n = 30) received fentanyl 2 μg/kg plus midazolam 0.02 mg/kg over 10 min. Adequacy of intubation condition was evaluated by cough score and postintubation score. Incidence of desaturation, hemodynamic changes, and sedation using Ramsay sedation scale were noted and compared between two groups.Results:The demographic characteristics were comparable in the two groups (P > 0.05). The mean Ramsay sedation score in Group I was 3.13 ± 0.937 and Group II was 3.16 ± 0.949, and the comparison between two groups was statistically insignificant (P = 0.891). Cough scores and postintubation scores were favorable in dexmedetomidine group than midazolam–fentanyl group and were statistically significant with P < 0.001 and 0.0001, respectively. Group I also showed better hemodynamics and less episodes of desaturation than Group II.Conclusions:Dexmedetomidine is more effective than midazolam–fentanyl during AFOI, as it provides better intubation condition, hemodynamic stability, and preservation of airway and spontaneous ventilation.

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Section: Discussionsupporting

confidence: 78%

“…In contrast with our study, Mondal et al . [ 17 ] observed higher sedation scores (3 ± 0.371) with dexmedetomidine group than fentanyl group (2.07 ± 0.254). ( P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study

et al. 2017

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“…[ 18 ] Another study used dexmedetomidine for awake fibre-optic bronchoscopy and did not find bradycardia, which can be explained by the use of glycopyrrolate prior to starting dexmedetomidine infusion, as done in our study also. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…Glycopyrrolate has also been used as an antisialogogic in previous study before the bronchoscopy. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery

et al. 2017

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Background and Aims:Awake fibre-optic intubation (AFOI) is an integral part of anaesthetic management of difficult airways. Conscious sedation is essential to assist AFOI. This study compared two different doses of dexmedetomidine in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation in patients undergoing elective cervical spine surgery with rigid cervical collar in situ.Methods:A randomized, prospective, comparative study design was conducted in sixty patients divided into two groups: Group (L) (n = 30) patients received low dose of dexmedetomidine (0.5 μg/kg) along with airway blocks and Group (H) (n = 30) patients received standard dose of dexmedetomidine (1 μg/kg) along with airway blocks. Both the groups received dexmedetomidine infusion over 10 min followed by airway block. Quantitative data were analysed by applying Student's t-test whereas qualitative data were analysed with Chi-square test. The objectives were to compare patients' Observer's Assessment of Alertness/Sedation scale (OAA/S) as primary outcome and other variables such as endoscopy, intubation condition, tolerance and haemodynamic stability among low and standard doses of dexmedetomidine.Results:Group H had more favourable OAA/S score than that of Group L, but endoscopy and intubation time, patient tolerance, vocal cord and limb movement and satisfaction score did not differ significantly between the groups. There were no significant haemodynamic differences between the two groups.Conclusion:The 0.5 μg/kg dose of dexmedetomidine was found optimal and effective in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation for patients undergoing elective cervical spine surgery.

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“…Monitored anesthesia care has been widely used in many clinical fields such as gastrointestinal endoscopy, septoplasty, thyroplasty, interventional or radiological procedures, cataract surgery, and awake bronchoscopy intubation (Bekker and Sturaitis, 2005; Busick et al, 2008; Goksu et al, 2008; Dogan et al, 2010; Parikh et al, 2013; Mondal et al, 2015). It can provide suitable intraoperative conditions for both patients and surgeons alike while avoiding the adverse reactions of GA, e.g., hemodynamic instability and prolonged emergence.…”

Section: Discussionmentioning

confidence: 99%

The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

et al. 2016

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Background: Chronic subdural hematoma (CSDH) is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA) and monitored anesthesia care (MAC) can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX) is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery.Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n = 67, DEX infusion at 0.5 μg·kg−1 for 10 min), Group D2 (n = 75, DEX infusion at 1 μg·kg−1 for 10 min), and Group S (n = 73, sufentanil infusion 0.3 μg·kg−1 for 10 min). Ramsay sedation scale (RSS) of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36 ± 4.23 vs. 13.42 ± 2.12 vs. 15.98 ± 4.58 min, respectively, for D1, D2, S; P < 0.001). More patients in groups D1 and S required rescue midazolam to achieve RSS = 3 (74.63 vs. 42.67 vs. 71.23%, respectively, for D1, D2, S; P < 0.001). However, the total dose of rescue midazolam was significantly higher in group D1 (2.8 ± 0.3 vs. 1.9 ± 0.3 vs. 2.0 ± 0.4 mg, respectively, for D1, D2, S; P < 0.001). The time to first dose of rescue midazolam was significantly longer in group D2 (17.32 ± 4.47 vs. 23.56 ± 5.36 vs. 16.55 ± 4.91 min, respectively, for D1, D2, S; P < 0.001). Significantly fewer patients in groups S and D2 required rescue fentanyl to relieve pain (62.69 vs. 21.33 vs. 27.40%, respectively, for D1, D2, S; P < 0.001). Additionally, total dose of rescue fentanyl in group D1 group was significantly higher (212.5 ± 43.6 vs. 107.2 ± 35.9 vs. 98.6 ± 32.2 μg, respectively, for D1, D2, S; P < 0.001). Total number of patient movements during the burr-hole surgery was higher in groups D1 and S (47.76 vs. 20.00 vs. 47.95%, respectively, for D1, D2, S; P < 0.001). Four patients in D1 and five in S converted to propofol. The time to recovery for discharge from the PACU was significantly shorter in group D2 (16.24 ± 4.15 vs. 12.48 ± 3.29 vs. 15.91 ± 3.66 min, respectively, for D1, D2, S; P < 0.001). Results from the patient and surgeon satisfaction scores showed significant differences favoring group D2 (P < 0.05). More patients in groups D1 and S showed higher levels of the overall incidence of tachycardia and hypertension, and required higher doses of urapidil and esmolol (P < 0.05). Six patients experienced respiratory depression in group S...

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Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study

Cited by 49 publications

References 25 publications

Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study

Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study

Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery

The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

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