Evaluate the efficacy of dexmedetomidine and fentanyl-midazolam combination on awake fiberoptic intubation in oral cancer surgery

Abstract

Background: Awake fiberoptic intubation (AFOI) is the principal techniques in the management of difficult airway in oral cancer surgery. The aim of study was to evaluate the efficacy of dexmedetomidine and fentanyl-midazolam combination on awake fiberoptic intubation in oral cancer surgery. An ideal sedation regimen would ensure patient’s comfort and co-ordination attenuation of airway reflexes, hemodynamic stability and sedation. Methods: 60 patients of age group 18-60 years with American Society of Anaesthesiologist I and II posted for oral cancer surgery under general anaesthesia were randomly divided into two groups of 30 each in this prospective randomised and comparative study. Group-D (30 pt): Received an infusion of 1 µg /kg in 100ml Normal saline infusion IV over 10 min. Group-FM (30 pt): Received an infusion of fentanyl 2 µg /kg and midazolam 0.02mg/kg IV in 10ml of normal saline. All Patients were assessed for vocal cord movement, coughing, physical movement, comfort score, Ramsay sedation score, patient satisfaction score, and intubation time and hemodynamics variables. Results: The demographic characteristics were comparable in two groups (P>0.05).Group-D has more incidence of vocal cord opening than Group-FM. Group-D has less cough score than group-FM. Limb movement scores were more in group-FM than group-D. Group-D were more satisfied than group-FM (P=0.0002). RSS Score was significantly better in Group-D than in Group-FM (P=0.041). Group-D showed significantly reduced hemodynamic response to AFOI than group-FM. Conclusion: Dexmedetomidine is more effective than fentanyl-midazolam during AFOI, as it provides better intubation condition, hemodynamics stability and sedation.