Dexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation: a double-blinded randomized controlled trial

Abstract

Awake fiberoptic nasotracheal intubation is usually performed in patients with an anticipated difficult airway. This study compares dexmedetomidine and remifentanil for conscious sedation during fiberoptic intubation. Forty patients undergoing elective awake fiberoptic nasotracheal intubation were allocated randomly to receive either dexmedetomidine (n=20) or remifentanil (n=20). Primary outcome measures were endoscopy, intubation, and post-intubation conditions as scored by the attending anesthesiologist. Other parameters included the time taken to achieve the desired level of sedation, endoscopy time, intubation time, and hemodynamic changes during the procedure. An interview was conducted 24h after surgery to evaluate patients' recall of and satisfaction with the procedure. The median [interquartile range] endoscopy score (graded 0-5) in the dexmedetomidine group (2 [1-2]) was significantly better than in patients who received remifentanil (3 [2-3]; p<0.01). Recall of intubation was significantly lower in the dexmedetomidine group (p=0.027). Dexmedetomidine provided better patient satisfaction than remifentanil (2 [1-2] and 2 [2-3], respectively; p=0.022). Patients in the dexmedetomidine group had fewer heart rate responses during endoscopy and intubation as compared to the remifentanil group (p<0.001 and p=0.004, respectively). Peripheral oxygen saturation was less in the remifentanil group during endoscopy (p=0.003). There were no significant differences in intubation and post-intubation conditions. Both dexmedetomidine and remifentanil were effective as sedatives in patients undergoing awake fiberoptic nasotracheal intubation. Compared with remifentanil, dexmedetomidine offered better endoscopy scores, lower recall of intubation, and greater patient satisfaction, with minor hemodynamic side effects.