A prospective randomized controlled study to assess the efficacy of fentanyl and dexmedetomidine for conscious sedation in awake fiberoptic intubation

Abstract

Background: Awake fiberoptic intubation (AFOI) is usually the primary method for airway management in patients with anticipated difficult airway. To achieve optimal conditions for AFOI, the pharmacological agents chosen for sedation should be short acting and have little suppression of spontaneous ventilation. Aims and Objectives: The aim of this study was to compare the efficacy between dexmedetomidine and fentanyl for conscious sedation in AFOI. The objectives were to assess the intubating conditions, intubation attempts, and the hemodynamic responses between the groups receiving the two drugs. Materials and Methods: This prospective randomized double-blind study was done in 40 patients of the American Society of Anesthesiologists physical statuses I, II, and III, aged between 20 and 65 years. One group received fentanyl 2 mcg/kg infusion over 10 min. The other group received dexmedetomidine 1 mcg/kg infusion over 10 min. AFOI was done in both groups when patients achieved Ramsay sedation score of three. Time to sedation and time to intubation were noted. Intubating conditions were assessed with cough score. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation were also monitored for 30 min with 3 min interval after starting the drug infusion. The number of intubation attempts was also noted. Results: We found that the time to sedation and the time to intubation were shorter with dexmedetomidine than with fentanyl. There were no significant differences in cough score, number of intubation attempts, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation between the groups. Conclusion: Both dexmedetomidine and fentanyl can be used to achieve adequate sedation for AFOI along with regional block and topical anesthesia. However, dexmedetomidine achieved target sedation faster compared to fentanyl enabling early intubation.