Comparison of Efficacy of Two Different Dose Regimens of Intravenous Dexmedetomidne for Awake Transnasal Fibreoptic Intubation

Abstract

Background and Objectives: Nasal Fibreoptic intubation (NFI) is the recommended technique in patients with difficult airway like facial defects, limited mouth-opening and cervical instability but it requires the patient to be awake. The usage of an ideal sedative agent and stabilizing the intubating condition was essential for this. In this study we compare efficacy of different doses of dexmedetomidine for conscious sedation facilitating NFI. Materials and Methods: This is a prospective, blinded-randomized-trial to correlate the effectiveness of different loading and maintenance doses of dexmedetomidine during NFI on 60 patients, 30 in each group, aged between 20 and 60 years with ASA grade I or II enrolled for elective surgery. All patients received 2 mg Midazolam as premedication before transferring to operating room. Group A patients received Dexmedetomidine 1 mcg/kg I.V bolus slowly over 10 minutes then 0.8 mcg/kg/h as maintenance throughout the procedure. Group B patients received Dexmedetomidine 0.8 mcg/kg I.V. as bolus and 0.2 mcg/kg/h as maintenance dose. Primary outcomes were assessment of sedation level and comfort of each patient by Total Comfort Scale (TCS). The difference in quantitative measures was done using student ‘t’ test and difference in proportions by ‘Chi’ square test. P<0.05 was considered statistically significant. Results: With respect to comfort scores and optimal conditions during NFI, Group A people showed significantly lower scores when compared to Group B. Conclusion: Dexmedetomidine with loading 1μg/kg and higher maintenance dose 0.8μg/ kg/h were better for NFI with better patient tolerance, patient comfort, patient satisfaction, good sedation and preserved upper airway with spontaneous breathing. Key words: Comfort scale; Dexmedetomidine; Fibreoptic intubation.