Comparison of intravenous dexmedetomidine alone versus dexmedetomidine ketamine combination on sedation intubation response safety profile and patient satisfaction during awake fiberoptic nasotracheal intubation

Abstract

Awake fiberoptic intubation requires adequate airway anaesthesia along with good sedation to achieve patient cooperation during intubation without respiratory depression and hypoxia.The purpose of this study was to compare dexmedetomidine alone and dexmedetomidine with ketamine in order to achieve an ideal regimen during awake fiberoptic intubation by providing sedation, good intubating conditions, better hemodynamic stability, and patient satisfaction.This prospective, randomised, double-blind clinical trial included 60 patients who were scheduled for elective surgery under general anaesthetic and required nasotracheal intubation. Patients were randomly assigned to two groups of 30 each, with ages ranging from 18 to 65 years and ASA grades I and II. All patients received an inj. dexmedetomidine bolus at 1 mcg/kg over 10 min. followed by a study drug depending on the group. In Group A, patients will receive an inj. ketamine 15 mg bolus and a 20 mg/hr ketamine infusion, whereas those in Group B will receive a normal saline bolus and infusion till completion of intubation. Sedation by Ramsay sedation scale (RSS), intubation response (by coughing score and grimace score), hemodynamic stability was observed during awake fiberoptic intubation, and patients' satisfaction by visual analogue score (VAS) and recall of events were assessed post operatively at 24 hours. In Group A with greater hemodynamic stability compared to Group B, RSS and Post-Operative Vas Score were more successfully attained. A combination of dexmedetomidine and ketamine provides the optimum sedation, hemodynamic stability, and patient satisfaction during awake fiberoptic intubation.