Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation

Abstract

Background:Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation.Methods:Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified “spray-as-you-go” technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg−1·h−1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg−1·h−1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers’ Assessment of Alertness/Sedation of 2–3. The quality of intubation conditions and adverse events were observed.Results:The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2 after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P < 0.05).Conclusions:Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.

Dexmedetomidine in the Management of Awake Fiberoptic Intubation

“…In this study, the results were found to be comparable for the two groups in terms of patients' tolerance and intubating conditions without affecting the patency of the upper airway. However, it has proved to be important to keep patients of sufentanil group responsive and compliant for the potential risk of respiratory depression [43]. Compared with placebo, in a multicenter study, Bergese et al evaluated the safety and efficacy of DEX for Sedation During AFOI, showing that considerably less DEX patients than placebo patients needed midazolam to obtain and sustain the required sedation.…”

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

“…It can induce a 'wakable' state that is similar to normal sleep. There are many studies on the use of dexmedetomidine in awake fiberoptic bronchoscopy intubation (AFOBI) [7]. A recent review reported that dexmedetomidine can cause fewer desaturation episodes than propofol and opioids when used in AFOBI [8].…”

Effect of dexmedetomidine on endotracheal intubating conditions during endotracheal intubation without neuromuscular blocker following propofol/remifentanil

“…In addition, when used as an adjuvant for induction of anesthesia, dexmedetomidine improves hemodynamic stability by decreasing the hemodynamic changes caused by endotracheal intubation [14]. Furthermore, dexmedetomidine is known to have sedative and airway reflex blunting effects, providing better conditions for awake fiberoptic intubation, awake blind nasotracheal intubation, and laryngeal mask airway placement when used with propofol [15][16][17].…”