Application of fiberoptic bronchoscopic-assisted nasotracheal intubation under awake induction with dexmedetomidine in ankylosing spondylitis patients

Abstract

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group. Group D: topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF: intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil. Fiberoptic bronchoscopic(FOB)-assisted awake nasotracheal intubation was performed. Mean arterial pressure (MAP), heart rate (HR), Pulse oxygen saturation (SpO2), Ramsay score and success rate of intubation were recorded and compared between two groups. The intubation conditions and level of comfort were also evaluated. MAP and HR of group D at FOB through postnaris(T1), peep the epiglottis(T2), intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P<0.05 or P<0.01) than those of group MF while Ramsay sedation scores were obviously higher (P<0.05) than those of group MF. Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF. Immediately after intubation, level 3 scores in grade 1 of group D (n=21) were significantly higher than group MF (n=12); initial success rate of intubation in group D was obviously higher than that in group MF (70%, n=21 vs. 47%, n=14). And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37%, n=11 vs. 67%, n=20). Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness. Key words: Sopndylitis, ankylosing; Dexmedetomidine