Comparison of Hemodynamic Response of Dexmedetomidine vs Fentanyl-Midazolam Combination in Case of Awake Fiberoptic Intubation in Patients With Anticipated

Dr. Anurag Gill; Dr. Sushil Kumar Bhati

Volume : IX, Issue : VI, June - 2020

Comparison of Hemodynamic Response of Dexmedetomidine vs Fentanyl-Midazolam Combination in Case of Awake Fiberoptic Intubation in Patients With Anticipated

Dr. Anurag Gill, Dr. Sushil Kumar Bhati

Abstract :

Background: Awake fiberoptic intubation (AFOI) is a technique of choice in known or anticipated difficult airway. AFOI can cause sympathetic stimulation that can be deleterious. Hence, current guidelines on AFOI recommend offering sedation to all patients. Various drugs have been used previously such as benzodiazepines, opioids, and propofol. These drugs cause sedation, amnesia, and attenuate the hemodynamic response but cause respiratory depression and hypoxemia. Hence, a sedative agent which allays anxiety and discomfort of the patient and decreases the sympathetic response without causing respiratory depression is ideal for such situations. The aim of the present study was to compare the hemodynamic response of dexmedetomidine vs fentanyl–midazolam combination in awake fiberoptic intubation. Methods: Hospital based, prospective, Randomized, double blind interventional study. 60 eligible cases were randomly allocated into 2 study groups (Group A and Group B). Group A patients received Inj. dexmedetomidine (1 �g/kg) i.v. in 10 ml NS over 10 minutes, while Group B patients received Inj. fentanyl (2 �g/kg) i.v. plus inj. midazolam (0.02 mg/kg) i.v. in 10 ml NS over 10 minutes. For statistical analysis unpaired–t–test and chi–square test were used. Results: In dexmedetomidine group the mean heart rate was significantly lower as compared to fentanyl–midazolam group at 4 min after fiberoptic scope insertion and at immediate post intubation (P < 0.001). The statistically significant difference in mean of mean arterial pressure was seen at 4 min and 6 min after fiberoptic scope insertion (P < 0.05), and highly significant difference at immediate post intubation (P < 0.001), while difference in mean rate pressure product was significant at 2 min and 6 min (P < 0.05), and highly significant at 4 min and immediate postintubation (P < 0.001) having better control with dexmedetomidine group. Cough score and post intubation tolerance score were favourable with dexmedetomidine group (P < 0.001). There was no significant difference in proportion of side effects in both study groups. Conclusion: Dexmedetomidine provides better hemodynamic stability and better intubating conditions as compared to fentanyl–midazolam combination.