Efficacy of dexmedetomidine versus remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope

Abstract

Objective To compare the efficacy of dexmedetomidine and remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope.Methods Forty ASA Ⅰ -Ⅲ aged 18-73 patients with difficult airways undergoing awake nasotracheal intubation assisted by fiberoptic bronchoscope were randomly divided into 2 groups ( n =20 each): dexmedetomidine group (group D) and remifentanil group (group R).A loading dose of dexmedetomidine 1.0 μg/kg was injected iv and then infused at a rate of 0.5 μg·kg-1 ·h-1 in group D.Remifentanil was target controlled-infused with target plasma concentration of 3.2 ng/ml in group R.Awake nasotracheal intubation was performed after dexmedetomidine loading dose was injected in group D and when the target plasma concentration of remifentanil was reached.Ramsay score was recorded during intubation,and intubation conditions (vocal cord movement,coughing,limb movement) and tolerance (during and after intubation) were evaluated.The intubation time,rate of successful intubation,side effects during intubation and 24 h after surgery,satisfactory score of patient with intubation and memory of intubation were recorded.Results Ramsay score,the first attempt success rates of intubation and satisfactory score of patients with intubation were significantly higher,intubation conditions and tolerance were better,intubation time was shorter,incidence of side effects and memory score of intubation were lower in group D than in group R ( P ＜ 0.05).Conclusion Dexmedetomidine provides better intubation conditions,less side effects and awareness of intubation than remifentanil for awake nasctracheal intubation assisted by fiberoptic bronchoscope. Key words: Dexmedetomidine; Piperidines; Bronchoscopy; Intubation, intratracheal; Conscious sedation