Safety and efficacy of low-dose rocuronium in awake fiberoptic intubation

Abstract

Background As it can be manually manipulated and facilitates visualization around corners, use of an awake flexible fiberoptic bronchoscope has been established as the gold standard for difficult intubation since the 1960s. It is advisable to use conscious sedation to make the procedure easier and more tolerable. The aim of this study was to evaluate the safety and efficacy of using low-dose rocuronium in awake fiberoptic intubation. Patients and methods In an experimental prospective study, 90 patients of ASA grades I and II scheduled for elective surgery, with age range of 18-60 years, received sedation for awake fiberoptic intubation. The patients were divided into three groups of 30 patients each: group I received 1 mg/kg fentanyl and 0.05 mg/kg midazolam; group II received 1 mg/kg fentanyl, 0.05 mg/kg midazolam, and 0.05 mg/kg rocuronium; and group III received 1 mg/kg fentanyl, 0.05 mg/kg midazolam, and 0.1 mg/kg rocuronium. Hemodynamic changes, hypoxia, hypercapnia, sedation score, position of vocal cords, time taken for intubation, cough, sore throat, vomiting, bleeding in airways, bronchospasm, patient discomfort, and any other side effects were noticed and recorded. Results Sedation score in group III was significantly higher than in the other two groups ( P = 0.04). There was significant decrease in time taken to intubate in group III when compared with group I or group II ( P = 0.041). Patient satisfaction in group III was significantly higher than in group I ( P = 0.02). Incidence of cough in group I was significantly high when compared with groups II and III ( P = 0.001). No significant differences were seen between groups regarding hemodynamic changes, hypoxia, hypercapnia, position of vocal cords, cough, sore throat, bleeding, bronchospasm, vomiting, and vagal faint. Conclusion Addition of low-dose rocuronium at 0.1 mg/kg to fentanyl and midazolam during awake fiberoptic intubation is more efficient, safer, and better than addition of 0.05 mg/kg rocuronium or usage of fentanyl and midazolam alone with regard to sedation score, time taken for intubation, and patient satisfaction.