Abstract
BackgroundThe purpose of this study was to compare the efficacy and safety of dexmedetomidine versus remifentanil for sedation during awake intubation using a Shikani optical stylet (SOS).MethodsSixty-eight patients with cervical trauma or severe cervical spondylosis undergoing cervical spinal surgery were enrolled in this prospective study. They were randomly assigned to receive dexmedetomidine (Group D) or remifentanil (Group R). In Group D, the patients received an intravenous loading dose of dexmedetomidine 1 μg · kg−1 over 10 min followed by a continuous infusion of 0.7 μg · kg−1 · h−1. In Group R, a target-controlled infusion of remifentanil was administered to achieve a plasma concentration of 2.5 ng · ml−1, increased to 3 ng · ml−1 10 min later. An endotracheal tube was inserted using a SOS under dexmedetomidine or remifentanil sedation after topical anesthesia to the airway. Midazolam was given as rescue sedation. We recorded the first attempt intubation success rate, the dose of midazolam, duration of intubation, Ramsay Sedation Scale (RSS) score, tracheal tube tolerance score, duration of drug infusion, adverse events and patient satisfaction score.ResultsThe RSS score was significantly higher in Group D than in Group R. First attempt success rate, rescue midazolam dose and the duration of intubation did not differ between the groups. Patients in Group R were significantly more tolerant of the tracheal tube. The incidence of hypoxia was significantly higher in Group R than Group D, but there was no significant difference in the incidence of other adverse events between the groups. The hemodynamic responses of the two groups were similar, but more patients in Group R were able to recall airway instrumentation.ConclusionsBoth dexmedetomidine and remifentanil are effective sedatives for awake intubation using an SOS. Although the first attempt success rates were similar, patients sedated with remifentanil tolerated the tracheal tube better after intubation with moderately increased risk of desaturation.Trial registration www.chictr.org.cn; ChiCTR-TRC-13003052 (February 4th, 2013).
Highlights
The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus remifentanil for sedation during awake intubation using a Shikani optical stylet (SOS)
The baseline Ramsay Sedation Scale (RSS) of the two groups were similar (Table 2), but RSS was significantly higher in Group D than in Group R 10 min after drug infusion (Table 2, P = 0.001)
The first intubation attempt success rates and the need for rescue midazolam were similar between the groups (Table 2)
Summary
The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus remifentanil for sedation during awake intubation using a Shikani optical stylet (SOS). The SOS is an effective means of managing patients with a difficult airway [1,2,3,4,5,6]. Awake intubation using the SOS in a patient with a difficult airway has been reported in two cases [3, 8]. Intravenous midazolam, propofol and remifentanil are commonly used as sedatives for awake fiberoptic endoscope intubation (AFOI), and there have been recent reports of the safe and effective use of dexmedetomidine [9,10,11,12,13,14]. Two studies compared dexmedetomidine with remifentanil for AFOI, but their results were contradictory [9, 10]
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