Comparison of dexmedetomidine, fentanyl, ketamine nebulization as an adjuvant to lignocaine for awake fibreoptic intubation: A randomised control trial

Abstract

Awake fibreoptic intubation (AFOI) is a crucial technique in managing difficult airways, and local anaesthetic nebulization is the most commonly used method for anesthetizing the airway. This study focuses on comparing the efficacy of dexmedetomidine, fentanyl, and ketamine nebulization when used as adjuvants to lignocaine during AFOI. This study aims to compare the effect of nebulised dexmedetomidine, fentanyl, and ketamine as an adjuvant to 4% lignocaine. The primary objective is to determine the cough score during the procedure and secondary objective is to look for sedation and any adverse effects. 84 participants who required awake fibreoptic intubation of any gender and between the ages of 18 and 65 were divided into 4 equal groups at random: Along with nebulised 4% lignocaine, group A received dexmedetomidine (1 mcg/kg), group B received fentanyl (2 mcg/kg), group C received ketamine (2 mg/kg), and group D received normal saline. Each group contained 21 people. Cough scores and Glottis visibility were observed and additionally Ramsay sedation score (RSS) and any other side effects were monitored.No cough was observed in 76.2% of Groups A and B, 66.7% in Group C and 0% in group D which was statistically, a very high significant difference, amongst the participants in four groups P = 0.000 (p<0.05). The glottis was open in 100% in Group C, 90.5% in Group A, 85.7% in Group B, and 71.4% in Group D with significant statistical difference amongst the groups(p = 0.006) (p<0.05). Participants who were anxious, agitated and restless were 100% in group D, 38.1% in Group C, 14.3% in Group A, and 4.8% in Group B, with significant difference. p = 0.000 (p<0.05). No adverse effects were noted in any of the group participants.Nebulised dexmedetomidine and fentanyl produced satisfactory airway preparation for awake fibreoptic intubation when compared to ketamine and plain lignocaine, although sedation was higher in the fentanyl group.