A COMPARATIVE STUDY TO EVALUATE THE EFFECTIVENESS OF DEXMEDETOMIDINE VERSUS PROPOFOL INTRAVENOUS INFUSION TO FACILITATE AWAKE FIBREOPTIC NASOTRACHEAL INTUBATION.

DR MANDAVILLI VIJAY KANTH

Volume : IX, Issue : V, May - 2019

A COMPARATIVE STUDY TO EVALUATE THE EFFECTIVENESS OF DEXMEDETOMIDINE VERSUS PROPOFOL INTRAVENOUS INFUSION TO FACILITATE AWAKE FIBREOPTIC NASOTRACHEAL INTUBATION.

Dr Mandavilli Vijay Kanth

Abstract :

Awake fiberoptic intubation (AFOI) is the most valuable technique in the management of difficult airway. This study aimed to compare the effectiveness of dexmedetomidine vs propofol infusion in providing conscious sedation during AFOI Method: Sixty eight patients with anticipated difficult intubation posted for elective surgery were enrolled and randomly allocated into the dexmedetomidine (groupA) (0.4mcg/kg bolus infusion over 10 min, followed by0.12mcg/kg/min) (n = 34) or the propofol (groupB)(0.8mg/kg bolus infusion over 10 min, followed by 0.08 mg/kg/min) (n = 34). Endoscopy and intubation conditions, level of sedation amnesia and patient satisfaction as graded by a scoring system were evaluated as the outcomes. Results: Intubation was successful in all patients. There was statistically significant difference in mean endoscopy score (1.71 vs 2.15), mean intubation scores for vocal cord movement (1.29 vs 1.68 ) and the mean postintubation scores (1.68 vs 2.21 ) whereas no statistically significant difference was found in mean endoscopy scores for coughing (1.79 vs 2.15) and limb movement (1.53 vs1.82 ) The time taken for endoscopy (116.94 seconds vs 124.32 seconds ) and for the intubation (27.21seconds vs27.06 seconds)were similar in two groups .Patients in the propofol group had a significantly higher level of sedation (OAA/S score 2.76vs4.65). Recall of endoscopy and intubation was(gp A vs gpB;82.4% vs 23.5%). There was no statistically significant difference regarding patient satisfaction between the two groups Conclusion: Dexmedetomidine and propofol both were effective for providing conscious sedation during awake fieoptic nasotracheal intubation.Dexmedetomidine provided better endoscopy and intubation conditions,similar haemodynamic stability without causing any respiratory distress.