Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial

Verma, Anil; Verma, Shipra; Barik, Amiya Kumar; Kanaujia, Vinay; Arya, Sangeeta

doi:10.1016/j.bjane.2021.01.005

Cited by 8 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 Also, awake fiberoptic intubation may circumvent the need for deep anesthetic sedation or be done in conjunction with dexmedetomidine as minimal changes in MAP were observed. 10,24 Our data showed that PH patients required higher doses of vasopressors in the immediate post-intubation period, and increased vasopressor requirements were significantly associated with increased in-hospital mortality. While disease severity may have been a confounding factor, our findings suggest that maintaining hemodynamic stability after ETI in the PH population may be crucial.…”

Section: Discussionmentioning

confidence: 74%

See 1 more Smart Citation

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Hong

Toppen

Lee

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

Background: Emergent endotracheal intubations (ETI) in pulmonary hypertension (PH) patients are associated with increased mortality. Post-intubation interventions that could increase survivability in this population have not been explored. We evaluate early clinical characteristics and complications following emergent endotracheal intubation and seek predictors of adverse outcomes during this post-intubation period. Methods: Retrospective cohort analysis of adult patients with groups 1 and 3 PH who underwent emergent intubation between 2005-2021 in medical and liver transplant ICUs at a tertiary medical center. PH patients were compared to non-PH patients, matched by Charlson Comorbidity Index. Primary outcomes were 24-h post-intubation and inpatient mortalities. Various 24-h post-intubation secondary outcomes were compared between PH and control cohorts. Results: We identified 48 PH and 110 non-PH patients. Pulmonary hypertension was not associated with increased 24-h mortality (OR 1.32, 95%CI 0.35-4.94, P = .18), but was associated with inpatient mortality (OR 4.03, 95%CI 1.29-12.5, P = .016) after intubation. Within 24 h post-intubation, PH patients experienced more frequent acute kidney injury (43.5% vs. 19.8%, P = .006) and required higher norepinephrine dosing equivalents (6.90 [0.13-10.6] mcg/kg/min, vs. 0.20 [0.10-2.03] mcg/kg/min, P = .037). Additionally, the median P/F ratio (PaO2/FiO2) was lower in PH patients (96.3 [58.9-201] vs. 233 [146-346] in non-PH, P = .001). Finally, a post-intubation increase in PaCO2 was associated with mortality in the PH cohort (post-intubation change in PaCO2 +5.14 ± 16.1 in non-survivors vs. −18.7 ± 28.0 in survivors, P = .007). Conclusions: Pulmonary hypertension was associated with worse outcomes after emergent endotracheal intubation than similar patients without PH. More importantly, our data suggest that the first 24 hours following intubation in the PH group represent a particularly vulnerable period that may determine long-term outcomes. Early post-intubation interventions may be key to improving survival in this population.

show abstract

Section: Discussionmentioning

confidence: 74%

“… 23 Also, awake fiberoptic intubation may circumvent the need for deep anesthetic sedation or be done in conjunction with dexmedetomidine as minimal changes in MAP were observed. 10 , 24 …”

Section: Discussionmentioning

confidence: 99%

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Hong

Toppen

Lee

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…It concluded that dexmedetomidine provided better intubating conditions and hemodynamic stability. 28 Similar success with dexmedetomidine is seen in the pediatric population presenting with difficult airways. 29…”

Section: Role In Difficult Airwaymentioning

confidence: 79%

Use of Dexmedetomidine for Anesthesia and Pain Management

Nazir¹,

Khan²

2022

Anaesth. pain intensive care

View full text Add to dashboard Cite

Background & objective: Since 1999, dexmedetomidine has been used in several patient populations after its approval as a sedative by the FDA. Subsequently, a large number of clinical trials on its benefits have been published widely in the literature. This review aims to update readers regarding recent evidence for approved as well as novel uses of dexmedetomidine and identify future areas of clinical research involving this relatively new drug. Sources: Randomized controlled trials conducted between January 2000 and August 2021, which compared dexmedetomidine with other sedative agents used in adult and pediatric patients undergoing mechanical ventilation in ICU, bronchoscopy and endoscopic procedures, general and locoregional anesthesia and chronic pain management were included in this review of the literature. PubMed, Science Direct, the Cochrane library and Google Scholar were used as databases. Implications: Dexmedetomidine is a multipurpose drug that has found unparalleled utility in intensive care medicine and anesthesiology. Its various advantages over traditional sedative agents have been documented, including decreased duration of mechanical ventilation, decreased incidence of delirium, perioperative analgesia and organ protective properties. Recently there has been mounting interest in dexmedetomidine as an analgesic adjunct in chronic and cancer pain management. However, there is still a paucity of well controlled studies evaluating the use of dexmedetomidine outside of a traditional sedative/analgesic role. The future direction of the research may focus on long term clinical benefits of dexmedetomidine in certain perioperative populations and its non-conventional use in palliative care and pain medicine. Citation: Ahmed WN, Khan AW. Use of dexmedetomidine for anesthesia and pain management: an updated review of literature. Anaesth. pain intensive care 2022;26(5):702-709; DOI: 10.35975/apic.v26i5.2020

show abstract

“…Multiple studies also assessed the use of opioid-based sedation techniques for AFOI, including fentanyl, remifentanil, and sufentanil [24–27,28 ▪▪ ,29,31,32]. Xu et al [24] demonstrated that a target-controlled infusion of remifentanil led to decreased coughing compared with intravenous dexmedetomidine, though also resulted in a higher incidence of patient recall and hypoxia, without improvement in success rate on first intubation attempt.…”

Section: Sedation Methodsmentioning

confidence: 99%

“…Though not every combination of sedatives has been assessed in a randomized trial, it is likely that a balanced technique with multiple sedatives can provide the benefits of each sedative, while minimizing the risks associated with each medication. Table 2 describes recent comparative evidence of various methods of intravenous sedation for awake intubation [24,25 ▪ ,26,27,28 ▪▪ ,29–33]. Many studies assessed the efficacy of intravenous dexmedetomidine in the setting of awake intubation, and revealed that it often led to shorter time to intubation, higher patient satisfaction, greater hemodynamic stability, fewer incidences of oxygen desaturation and/or hypercarbia postintubation, decreased coughing, and better intubating conditions [24,25 ▪ ,26,27,28 ▪▪ ,29–33].…”

Section: Sedation Methodsmentioning

confidence: 99%

Comparative review of airway anesthesia and sedation methods for awake intubation

Rao

Soffin

Beckman

2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewSuccessful awake intubation hinges upon adequate airway anesthesia and sedation for patient comfort. This review will summarize relevant anatomy and regional anesthesia techniques to achieve airway anesthesia, and compare various airway anesthesia and sedation regimens. Recent findingsOverall, nerve blocks consistently provided superior airway anesthesia, shorter time to intubation, higher patient comfort, and higher postintubation patient satisfaction. Additionally, ultrasound guidance can further provide benefit by reducing the amount of local anesthetic administered, leading to denser blockade, and proving invaluable in challenging clinical situations. Regarding sedation methods, numerous studies supported the use of dexmedetomidine, with or without the addition of supplemental sedation, such as midazolam, ketamine, or opioids.

show abstract

Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial

Cited by 8 publications

References 18 publications

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Use of Dexmedetomidine for Anesthesia and Pain Management

Comparative review of airway anesthesia and sedation methods for awake intubation

Contact Info

Product

Resources

About