Awake Fiberoptic Research Articles

Dexmedetomidine vs. Fentanyl for Awake Fiberoptic Intubation Among Adults in Tamil Nadu - A Randomized Control Trial.

Background: Dexmedetomidine and fentanyl are often administered medications for inducing conscious sedation, a technique employed for performing awake fibreoptic intubation. However, there is a scarcity of literature that directly compares the effects of these drugs when administered at equivalent doses. This study sought to assess the effectiveness and safety of using dexmedetomidine and fentanyl in adult patients undergoing Awake Fiberoptic Intubation (AFOI). Methodology: The current research study undertaken was a randomized controlled trial conducted among adult patients at A hospital providing specialized medical services in Salem, Tamil Nadu. There were 60 study participants, 30 participants in each group. A group received the drug dexmedetomidine 1-µg/kg while B group received fentanyl l-µg/kg intravenously. Primary outcomes measured were the efficacy of both drugs for sedation, patients’ comfort and compliance during AFOI, cough score, BP, HR, post-intubation score, and the Ramsay sedation score and SpO2 for 15 minutes intraoperatively. Results: The study found that 80% of study participants in A group had cough score below 2, compared to only 6.7% in group B. Post-intubation cooperation was also higher in group A, with 83.3% of patients showing cooperation. The Ramsay sedation score showed significant differences between the groups. Intubation length was shorter in group A, while group B experienced HR increased, SBP, and oxygen saturation. These findings highlight the importance of individualized care in patient care. Conclusion: Dexmedetomidine is superior to fentanyl for AFOI. Regarding the provision of heightened sedation, enhanced intubating circumstances, and increased tolerance to intubation, and greater hemodynamic stability, all within a shorter duration for intubation.

Sedation using Dexmedetomidine with or without Different Methods of Airway Topical Anesthesia for Awake Fiberoptic Nasal Intubation in Patients Undergoing Elective Surgeries under General Anesthesia

Sedation using Dexmedetomidine with or without Different Methods of Airway Topical Anesthesia for Awake Fiberoptic Nasal Intubation in Patients Undergoing Elective Surgeries under General Anesthesia

Double Tongue Appearance of Congenital Neck Mass: Successful Management of Restricted Airway with Awake Fiberoptic Nasal Intubation

Double Tongue Appearance of Congenital Neck Mass: Successful Management of Restricted Airway with Awake Fiberoptic Nasal Intubation

Opioid-free General Anesthesia and Awake Fiberoptic Intubation with Dexmedetomidine in a Class IV Obese Patient with Cervical Spondylosis

Abstract Patients with Class IV obesity (C4O) (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during the postoperative period, e.g., critical respiratory events (CREs) including respiratory arrest and oversedation, leading to problems with maintaining open airway, hypoxia, and hypercapnia. We present the case of a 67-year-old C4O (BMI 57.2 kg/m2) female patient with cervical spondylosis, scheduled for laparoscopic sleeve gastrectomy. Preanesthesia evaluation revealed hypertension, type 2 diabetes mellitus (DM), nonalcoholic steatohepatitis, and obstructive sleep apnea as comorbidities. Awake fiberoptic intubation was planned because of a high potential for difficult intubation (neck circumference of 45 cm, cervical spondylosis, reduced neck mobility, and type 2 DM), using topical anesthesia and dexmedetomidine (Dex) infusion. General anesthesia was given with desflurane and muscle relaxant. “Opioid-free anesthesia,” wherein use of systemic, neuraxial, or intracavitary opioids is completely eliminated, was maintained with Dex infusion for sedation and analgesia. Reversal of anesthesia was done in Fowler’s position (FP), and after extubation, nasopharyngeal airway connected to high-flow oxygen (10 L/min) via tubing was used, which facilitated spontaneous breathing, maintaining oxygen saturation and uneventful recovery. Postoperatively, intravenous paracetamol alone was adequate for effective pain relief. The patient remained hemodynamically stable throughout the perioperative period. This case underscores the benefits of “opioid-free anesthesia” using intraoperative Dex infusion and efficacious use of nasopharyngeal airway in FP postoperatively, avoiding requirement of ventilator, in supermorbidly obese patients, reducing CREs and optimizing postoperative outcomes.

Difficult Airway Management with Awake Fiberoptic Intubation and Cross Table Ventilation in a Case of Acquired TEF with Severe Subglottic Stenosis

We report a case of 30-year male who presented with Acquired Tracheoesophageal Fistula with subglottic stenosis and Aspiration Pneumonitis. Patient was managed with Feeding Jejunostomy, Tracheoesophageal Fistula repair and Tracheoplasty, after which patient recovered well. Difficult airway was managed by Awake Fiberoptic Intubation and cross-table ventilation through flexometallic tube intraoperatively during TEF repair.

A Case Series Reflecting Airway Difficulty Challenges: Insights into Intubation and Extubation for Large Retrosternal Goitres

Retrosternal goitres, often due to longstanding thyroid enlargement, can compress critical structures like the trachea and oesophagus, necessitating thyroidectomy. Managing the airway while ensuring patient safety presents a significant challenge for anaesthesiologists. This case series explores the complex airway management in three patients with large retrosternal goitres undergoing total thyroidectomy. The patients, aged 50, 60, and 73, presented with long-standing neck swelling, tracheal deviation and symptoms including breathlessness, dysphagia and hoarseness of voice. The goitres had progressively enlarged over many years, leading to significant tracheal compression and deviation, which posed a high-risk for airway obstruction during surgery. Given these challenges, Awake Fiberoptic Intubation (AFOI) was chosen to secure the airway while minimising the risk of airway loss. AFOI was performed under conscious sedation with dexmedetomidine and local anaesthesia, providing effective intubation with minimal discomfort and stable haemodynamics. This approach was critical in managing the anticipated difficult airway due to the retrosternal extension of the goitres and their impact on surrounding structures. Postoperatively, the patients were kept intubated to prevent tracheomalacia, a potential complication arising from prolonged tracheal compression. Tracheomalacia, characterised by the weakening of tracheal walls, can lead to airway collapse after extubation. To ensure airway stability, extubation was delayed until a satisfactory cuff-leak test was performed 24-36 hours after surgery. This case series emphasises the importance of careful preoperative planning and the use of AFOI in managing patients with large retrosternal goitres to avoid a ‘can’t intubate, can’t ventilate’ situation. The successful management of these cases highlights the effectiveness of AFOI in reducing perioperative risks and ensuring patient safety, particularly in scenarios where difficult airway management is anticipated. By implementing appropriate postoperative protocols, the risk of complications such as tracheomalacia can be significantly reduced, leading to improved surgical outcomes.

Comprehensive Case Study on Awake Fiberoptic Intubation for Ameloblastoma with a Challenging Airway

Comprehensive Case Study on Awake Fiberoptic Intubation for Ameloblastoma with a Challenging Airway

Comparison of Dexmedetomidine and Nalbuphine on Intubating Conditions and Hemodynamic Responses During Awake Fiberoptic Intubation: A Randomized Study

Background: The pre-requisites to a successful awake fiberoptic intubation (AFOI) include adequate psychological and pharmacological preparation of the patient. This study aims to compare two pharmacological agents, dexmedetomidine and nalbuphine, in addition to nebulization and airway topicalization, for intubating conditions during AFOI.
 Methods: Sixty consenting patients belonging to ASA I/II, MPC I/II, age-group of 18-60 years weighing between 40-70 kgs requiring general anaesthesia with endotracheal intubation were randomly allocated to one of the two groups. Patients received dexmedetomidine 1µg/kg i.v. (group D) or nalbuphine 0.2 mg/kg i.v. (group N) over 10 min before intubation. Fiberoptic intubation was attempted. Intubating conditions were assessed in terms of sedation score, cough score and post-intubation score. Hemodynamic responses, lignocaine and propofol requirement were also recorded. Repeated measure ANOVA, Tukey’s test, unpaired t test, Chi‑square test or Fisher’s exact test were used for data analysis. A P < 0.05 was considered significant.
 Results: Sedation score (P = 1.000), cough score (P = 0.165) and post‑intubation score (P = 0.157) were comparable among the two groups. Hemodynamic responses, propofol and lignocaine requirements were also comparable.
 Conclusion: Both intravenous dexmedetomidine and nalbuphine provide good intubating condition with minimal adverse effects on haemodynamic profile during awake fibreoptic intubation.

Awake Fiberoptic Intubation in Patients with a Difficult Airway: Comparison of Ivory North Pole and PVC Portex Tubes

Awake Fiberoptic Intubation in Patients with a Difficult Airway: Comparison of Ivory North Pole and PVC Portex Tubes

Awake Fiberoptic Intubation

We may have many devices in this 21st century, which can be used to secure the airway in patients who have been predicted to have a difficult airway. There are many studies about difficult airways and suggested various devices such as flexible fiberoptic scope, video laryngoscope, and the specialized intubating laryngeal mask airway and they ended up concluding one device better than another. Furthermore, ET intubation requires continued practice and carries with it its own set of complications. Technical problems with the placement of endotracheal tubes have been the most frequent cause of anesthetic deaths in published analyses from all over the world. The basic responsibility of an anesthesiologist is to maintain adequate gas exchange in patients by securing a patent airway through a proper device. Fiberoptic bronchoscopy and intubation have the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure, especially in the case of children. We report two such cases, where “Awake flexible fiberoptic-guided intubation” was considered the only desirable choice.

A Randomized Controlled Trial: Examining the Impact of the Novel Double Setup Endotracheal Tube on the Success Rates of Awake Fiber-Optic Orotracheal Intubation

Background: Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiber-optic intubation (AFOI) is often impeded. Various maneuvers and tracheal tubes designed to overcome this obstruction may also be unsuccessful or costly. Objective: The current study aimed to assess how the novel double configuration ETT affected AFOI success rates on the first attempt. Methods: A randomized controlled experiment including 40 individuals receiving awake fiber-optic orotracheal intubation was performed in a 1:1 ratio with a single ETT railroaded with its bevel posteriorly (ST) or railroading with a double setup ETT (DT) over a flexible videoscope (FVS) for tracheal intubation. The number of intubation attempts, time spent intubating, and adverse events were examined and compared between the two groups. Results: Twenty patients received a single ETT railroaded with the bevel posteriorly, and 20 patients received railroading with the double setup ETT during AFOI. Intubation on the first attempt was significantly greater in the DT group (90%) than in the ST group (35%). The intubation time was considerably shorter for the DT group (12.8 [7.8–16.9] s) when compared with the ST group (27.9 [16.3–91.0] s). Five patients were intubated by the alternative technique after failure to intubate for several attempts, and 3 cases were found to have a crease in the FVS after intubation in group ST. During topical anesthetic, three individuals in each group experienced transient oxygen desaturation. Conclusions: Our study discovered that the novel double setup tube could significantly improve the intubation success rate on the first attempt during AFOI for patients with challenging airway when a strategy based on a reduced gap between ETT and FB could not be applied.

Comparison of the safety and efficacy of propofol and dexmedetomidine as sedatives when used as a modified topical formulation

Purpose: To evaluate the safety and efficacy of propofol and dexmedetomidine as sedatives in patients with anticipated difficult airways, used as a modified topical preparation.Methods: A total of 432 patients were enrolled in this study. They were classified as ASA I and ASA II. The patients were equally divided into group A (propofol group) and group B (dexmedetomidine group). A modified Awake Fiberoptic Intubation (AFOI) was carried out for these patients, followed by airway assessment and evaluation of clinical outcome based on intubation scores, adverse events, and postoperative data.Results: Patients in both groups had successful intubation at the first attempt. There was no significant difference in baseline characteristics between the two groups. The SARI scores which characterized the overall score for tracheal intubation were 4.6 and 4.2 for groups A and B, respectively. With respect to rescue infusion and consciousness, 11 patients (5.09 %) in group A required rescue, as against 5 patients (2.31 %) in group B. Seven (7) patients (3.24 %) in group A (propofol group) had severe airway obstruction, while only 4 patients (1.85) in group B had the same adverse reaction. Patients in group B had more satisfactory and favourable outcomes than those in group A who were treated with modified AFOI.Conclusion: The use of dexmedetomidine based on modified topical anaesthesia is safe and comfortable in terms of patient convenience and difficult airway management. Thus, dexmedetomidine is a safe, feasible and effective method for managing difficult airway when applied using the modified AFOI.

Efficacy of Intranasal Dexmedetomidine with Lidocaine Versus Intranasal Lidocaine Alone in Awake Fiberoptic Nasotracheal IntubationA Randomised Clinical Study

Introduction: Awake Fiberoptic Intubation (AFOI) is considered as the gold standard technique in patients with predicted and unpredicted difficult airway. It is best performed with the patient awake to maintain spontaneous ventilation. Dexmedetomidine has been successful in several clinical settings including AFOI due to its diverse actions like sedation, analgesia, anxiolysis, cardiovascular stabilising effect and preservation of respiratory function. Aim: To assess the efficacy of using dexmedetomidine intranasally with lidocaine in AFOI in comparison to using lidocaine alone in terms of haemodynamic stability, sedation, ease of intubation, patient’s satisfaction with the procedure and reduction in intraoperative propofol requirement. Materials and Methods: This randomised clinical study was conducted on 100 patients of either gender aged between 18-60 years with ASA physical status I or II scheduled for elective surgeries under general anaesthesia at Government Medical College and Rajindra Hospital, Patiala, India from February 2021 to November 2021. The patients were randomly divided into two groups of 50 each namely Group D (intranasal dexmedetomidine 2 mcg/kg + lidocaine 10%) and Group L (intranasal lidocaine 10% alone). Maximum dose of 10% Lidocaine was <5 mg/kg body weight in both groups. The various parameters were recorded in both the groups during AFOI and the data was analysed using Statistical Package for Social Sciences (SPSS) software version 22.0 and Microsoft excel. Descriptive statistics was done for all data and were reported in terms of mean, standard deviation and percentages. Results: Among 100 patients, group D and group L comprises of 50 each. The mean heart rate during AFOI was 70.16±8.02 in Group D, and 95.62±11.04, in Group L. The Mean Arterial Pressure (MAP) during AFOI was 81.42±5.55 in group D and 101.78±6.22, in group L. There was statistically highly significant (p-value <0.001) decrease in mean heart rate and MAP (within normal clinical range) in group D as compared to group L. The mean Ramsay Sedation Scale (RSS) in group D was 3.66 ± 0.48 and in group L was 2.32±0.55 (p-value <0.001). There was a significant difference (p-value <0.001) in patient tolerance, time to intubation, propofol requirement, patient satisfaction and anaesthesiologist satisfaction between the two groups. There was no significant decrease in Saturation of Peripheral Oxygen (SpO2 ) or respiratory depression in both groups (p-value=0.221). Conclusion: Intranasal dexmedetomidine with lidocaine provides better haemodynamic stability and improves the quality of intubation, reduces propofol requirement, provides good patient and anaesthesiologist satisfaction and maintains oxygen saturation during AFOI.

Awake Fiberoptic Intubation in Vocal Cord Palsies

Respiratory distress associated with vocal cord palsy can be attributed to recurrent laryngeal nerve injury. Bilateral vocal cord palsy can cause adduction of cords and respiratory distress. Airway, in these patients, can be compromised and result in unanticipated difficult intubation. The time frame to pass tube in such situations are less. This is a case series on successful airway management of three patients who presented with recurrent nerve palsy and airway obstruction. Thus the “cannot intubate-cannot oxygenate” situation was avoided in all the patients.

Comparison of Cricothyroid Membrane Puncture Anesthesia and Topical Anesthesia for Awake Fiberoptic Intubation: A Double-Blinded Randomized Controlled Trial.

Background: Awake fiberoptic intubation (AFOI) is commonly used for patients with a difficult airway. The purpose of this study was to evaluate the efficacy of cricothyroid membrane puncture anesthesia and topical anesthesia during AFOI.Methods: A total of 70 patients (the American Society of Anesthesiologists score I-III) with anticipated difficult airways scheduled for nonemergency surgery with AFOI were randomly slated to receive cricothyroid membrane puncture anesthesia (n = 35) or topical anesthesia (n = 35). Each group received dexmedetomidine at a dose of 1.0 μg/kg and sufentanil at a dose of 0.2 μg/kg over 10 min for conscious sedation before intubation. The endoscopy intubation, post-intubation condition, and endoscopy tolerance as scored by the anesthetists were observed. The satisfaction of the operator regarding the procedure and the satisfaction of the patient 24 h after the surgery were also recorded. We recorded the success rate of the first intubation, intubation time, and hemodynamic changes during the procedure and also the adverse events.Results: Better intubation scores, operator satisfaction, and satisfaction of the patient were observed in the cricothyroid membrane puncture anesthesia group than in the topical anesthesia group (p < 0.05). The intubation time in the cricothyroid membrane puncture anesthesia group was less than that in the topical anesthesia group (p < 0.05). There were no significant differences in the patient tolerance scores, the success rate of the first intubation, hemodynamic changes, and adverse events between both the groups.Conclusion: Compared with topical anesthesia, cricothyroid membrane puncture anesthesia provided better intubation conditions and less intubation time with greater satisfaction of the patient and operator during endoscopic intubation.Clinical Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=42636, Identifier: ChiCTR 1900025820.

Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries

Abstract Background Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects. Aim The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation. Material and Methods A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups. Results Ramsy Sedation Score was significantly favorable (P &amp;lt; 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P &amp;lt; 0.05) and less intubation attempts were observed in group A in comparison to group B. Conclusion The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.

A Comparative Study of Airway Nerve Blocks and Atomized Lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic) Airway for Oral Awake Fiberoptic Intubation.

BackgroundAwake intubation is used most commonly in patients with a predicted difficult airway. There are situations where the safest method to secure an airway is to place an endotracheal tube in an awake and spontaneously breathing patient. Our aim was to compare the two modalities, airway nerve blocks and atomized lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic)airway for awake fiberoptic intubation (AFOI).MethodsA total of 50 patients with anticipated difficult airway requiring AFOI were randomly allocated into two groups. Group A received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal nerve) each with 2 ml of 2% lidocaine and group B received airway anesthesia through atomized lidocaine by LMA MADgic using 10 ml of 2% lidocaine. Fiberoptic guided orotracheal intubation was then performed in both the groups using LMA MADgic as the conduit. The primary outcome measured was intubation time and the secondary outcome included quality of intubation, hemodynamic variables, and any adverse events.ResultsThe intubation time was found to be significantly lower in Group A (63.80±7.86 seconds) as compared to Group B (184.96±13.38 seconds) (p=0.0001). The ease of intubation, intubating condition, and patient comfort were better in patients who received airway blocks. Group B had an increased number of coughing/gagging episodes as compared with Group A. Between the two groups, group A showed better hemodynamics and fewer episodes of desaturation than group B.ConclusionUpper airway nerve blocks provide faster intubation, adequate airway anesthesia, and less patient discomfort to aid in AFOI in patients with anticipated difficult airway as compared to topical anesthesia using an atomizer.

Anaesthesia for Awake Fiberoptic Intubation: Ultrasound-Guided Airway Nerve Block versus Ultrasonic Nebulisation with Lignocaine.

Background: In anticipated difficult airway, awake fiberoptic guided intubation should be the ideal plan of management. It requires sufficient upper airway anesthesia for patient’s comfort and cooperation. We compared the efficacy of ultrasound guided airway nerve blocks and ultrasonic nebulisation with lignocaine for airway anesthesia before performing awake fibreoptic guided intubation. Methods: This prospective, randomised study included sixty consenting adult patients of both genders (American Society of Anesthesiologists' physical status 1–3) with anticipated difficult airway undergoing surgery. Ultrasound guided airway nerve blocks group received ultrasound-guided bilateral superior laryngeal (1 ml of 2% lignocaine) and transtracheal recurrent laryngeal (2 ml of 2% lignocaine) airway nerve blocks and ultrasonic nebulisation with lignocaine group received ultrasonic nebulisation of 4 ml of lignocaine 4%. The primary outcome was to compare the time required to intubate, whereas the secondary outcomes were to compare cough reflex and gag reflex, hemodynamic changes, number of attempts required, and comfort score during awake fibreoptic guided intubation in both the groups. Results: The time taken for intubation was significantly lower in the ultrasound guided airway nerve blocks group 69.27±21.85 s than ultrasonic nebulisation with lignocaine group 92.43 ± 42.90 s (p = 0.015). Hemodynamic variables changed during the procedure but the values were comparable in both groups. There were no statistical differences in cough and gag reflexes, number of attempts, and comfort score in both groups. Conclusions: This study shows that significant lesser time required for performing awake fiberoptic intubation when patient received ultrasound guided airway nerve block in comparison to ultrasonic nebulisation for airway anaesthesia.

Dexmedetomidine vs Fentanyl for Awake Fiberoptic Intubation in Paediatric Patients with Temporomandibular Joint Ankylosis: A Retrospective Analysis

Introduction: For successful management of difficult paediatric airway intubation, proper preparation of airway along with a calm and sedated child with titrated doses of sedative agents is paramount. Aim: To compare two different classes of sedative agents (Dexmedetomidine vs Fentanyl) regarding intubating conditions and comfort score of paediatric population at the time of awake fiberoptic intubation. Materials and Methods: This retrospective study was carried out among 40 paediatric patients, aged between 5-14 years those who underwent surgery for Temporo-Mandibular Joint (TMJ) ankylosis. Clinical data relevant for this study was collected from the pre-format sheets of anaesthesia technique, attached with case files of the patients. Inj. dexmetedomidine bolus of 1 mcg/kg for 10 minutes followed by infusion at the rate 0.6 mcg/kg/hr in group A and Inj. fentanyl bolus dose of 2 mcg/kg followed by infusion 1 mcg/kg/hr in group B were compared in terms of intubating conditions and patient co-operation. For data analysis Statistical Package for the Social Sciences (SPSS) version 20 (IBM Inc.) was used. Patient characteristics in the two groups were compared using mean±SD and chi-square test. Results: All the patients had successful intubation in first attempt in both the groups. In terms of airway preparation, out of total, 14 (35%) patients in group A had no secretions as compare to 4 (10%) patients of group B (p-value was 0.002). In terms of cough score, 13 (32.5%) patients in group A had no cough as compared to 3 (7.5%) patients in group B. Patients in group A were more comfortable at the time of insertion of Flexible Fiberoptic Bronchoscopy (FOB) with no or less resistance to FOB insertion (p-value was 0.043). Vocal cord conditions were favourable in both the groups and there was no difference. Conclusion: Fiberoptic nasal intubation was found to be easier and safe in terms of patient comfort and preservation of patent airway with the use of dexmedetomidine, in paediatric TMJ ankylosis.

Comparison of Dexmedetomidine vs Midazolam for Sedation during Awake Fiberoptic Intubation in Oral Cancer Surgeries- A Randomised Clinical Study

Introduction: Fiberoptic nasotracheal intubation is a prime method for managing difficult airway in patients. Besides local blocks, some sedation is required during the procedure to make it more tolerable to the patients. Dexmedetomidine (DEX) and Midazolam (MDZ) can be used for this purpose. Aim: To compare dexmedetomidine versus midazolam for sedation and intubating condition during Awake Fiberoptic Intubation (AFOI) in patients undergoing oral cancer surgeries. Materials and Methods: This was a prospective randomised double blind study on total of 60 patients randomly allocated into group 1(MDZ) and group 2(DEX). Group 1 received intravenous (i.v.) Midazolam 0.05 mg/kg bolus in 10 mL normal saline over 10 minutes followed by 0.1 mg/kg/hr infusion titrated upto 0.2 mg/ kg/hr to achieve a Ramsay Sedation Score (RSS) ≥2. Group 2 (DEX) received i.v. Dexmedetomidine 1 μg/kg bolus in 10 mL normal saline over 10 minutes followed by infusion at the rate of 0.2 μg/kg/ hr titrated upto 0.7 μg/kg/hr to achieve a RSS ≥2. Comfort Scale values, haemodynamic parameters, patient’s tolerance score and patient’s satisfaction score (24 hours after the surgery) were assessed. Significance was calculated using Student t-test. The number of patients with adverse effects was compared using Chi- square test. Results: In the total sample of 60 patients (30 subjects in MDZ group and 30 subjects in DEX group). The demographic data, blood pressure and Oxygen(O2) saturation were comparable. Significant change in Heart Rate (HR) was observed in group MDZ while HR was stable in DEX group (p&lt;0.001). Group DEX patients were more comfortable and had greater endurance with tolerance score &lt;2.5 compared to MDZ group &gt;2.5 (p&lt;0.001) and had an acceptable level of RSS. After 24 hours, DEX group patients judged their sedation more positively than MDZ group with a score of 6.16 vs. 3.6 (p&lt;0.001). Conclusion: Both Midazolam and Dexmedetomidine are effective for AFOI. But Dexmedetomidine provided better patient comfort and satisfaction along with stable haemodynamics.