Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation： A Randomized Double-blind Study

• Published in: Chinese medical journal Vol. 128; no. 23; pp. 3143 - 3148
• Main Authors: Li, Cheng-Wen, Li, Yan-Dong, Tian, Hai-Tao, Kong, Xian-Gang, Chen, Kui
• Format: Journal Article
• Language: English
• Published: China Medknow Publications Pvt Ltd 05.12.2015; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Anesthesiology,Jining No.1 People's Hospital,Jining,Shandong 272011,China%Department of Anesthesiology,Affiliated Hospital of Jining Medical University,Jining,Shandong 272029,China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Adult; Airway management; Anesthesia; Anesthesiology; Awake Fiberoptic Intubation; Conscious Sedation; Dexmedetomidine; Midazolam; Sufentanil; Combination drug therapy; Comparative analysis; Conscious Sedation - methods; Dexmedetomidine; Dexmedetomidine - adverse effects; Dexmedetomidine - therapeutic use; Dosage and administration; Double-Blind Method; Double-blind studies; Drug dosages; Electroencephalography; Female; Fiber Optic Technology - methods; Health aspects; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Intubation; Intubation, Intratracheal - methods; Male; Midazolam; Midazolam - adverse effects; Midazolam - therapeutic use; Middle Aged; Narcotics; Original; Patients; Sufentanil; Sufentanil - adverse effects; Sufentanil - therapeutic use; Wakefulness; 气管插管; 纤维支气管镜; 芬太尼; 随机; 鼻; China; Conscious Sedation; Awake Fiberoptic Intubation; Midazolam; Sufentanil; Dexmedetomidine
• ISSN: 0366-6999; 2542-5641; 2542-5641
• DOI: 10.4103/0366-6999.170260

Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam （DM） and sufentanil with midazolam （SM） for sedation for awake fiberoptic nasotracheal intubation. Methods： Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups （n = 25 per group） by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified ＂spray-as-you-go＂ technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infllsion of 0.25 μg.kg^-1.h ^-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 rain followed by a continuous infusion of 0.1 μg.kg^-1.h ^-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose ofmidazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers＇Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed. Results： The scores of ease of the AFOI procedure, patient＇s reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups （z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P 〉 0.05）. Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO, after intubation was higher in Group SM than that in Group DM （45.2 ± 4.2 mmHg vs. 42.2 ±4.3 mmHg, t = 2.495, P 〈 0.05）. Conclusions： Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.