Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation： A Randomized Double-blind Study
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 intu...
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| Published in | Chinese medical journal Vol. 128; no. 23; pp. 3143 - 3148 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
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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 |
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| Abstract | 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. |
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| AbstractList | 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.
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 infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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.
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 CO2after 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).
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. 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.BACKGROUNDAwake 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.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 infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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.METHODSFifty 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 infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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.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 CO2after 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).RESULTSThe 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 CO2after 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).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.CONCLUSIONSBoth 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. 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 infusion of 0.25 μg·kg-1 ·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μtg·kg-1·h-L As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 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 CO2 after intubation cwas 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 forAFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen. 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 infusion of 0.25 μg·kg−1·h−1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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 CO2after 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. 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 infusion of 0.25 μg·kg−1·h−1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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 CO2after 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. 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 infusion of 0.25 μg·kg-1 ·h-1 , whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min 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 of midazolam 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 CO2 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. 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. |
| Audience | Academic |
| Author | Cheng-Wen Li Yan-Dong Li Hai-Tao Tian Xian-Gang Kong Kui Chen |
| AuthorAffiliation | 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, Chin |
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| Author_xml | – sequence: 1 givenname: Cheng-Wen surname: Li fullname: Li, Cheng-Wen organization: Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011 – sequence: 2 givenname: Yan-Dong surname: Li fullname: Li, Yan-Dong organization: Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029 – sequence: 3 givenname: Hai-Tao surname: Tian fullname: Tian, Hai-Tao organization: Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011 – sequence: 4 givenname: Xian-Gang surname: Kong fullname: Kong, Xian-Gang organization: Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011 – sequence: 5 givenname: Kui surname: Chen fullname: Chen, Kui organization: Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011 |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26612286$$D View this record in MEDLINE/PubMed |
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| DOI | 10.4103/0366-6999.170260 |
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| Discipline | Medicine |
| DocumentTitleAlternate | Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation： A Randomized Double-blind Study |
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| EndPage | 3148 |
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| Keywords | Conscious Sedation Awake Fiberoptic Intubation Midazolam Sufentanil Dexmedetomidine |
| Language | English |
| License | http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
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| Notes | 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. 11-2154/R Awake Fiberoptic lntubation： Conscious Sedation： Dexmedetomidine; Midazolam; Sufentanil ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Cheng-Wen Li and Yan-Dong Li contributed equally to this work. |
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| PublicationYear | 2015 |
| Publisher | Medknow Publications Pvt Ltd 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 |
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| Snippet | Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate... Background: Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate... Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the... Background: Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway.The aim of this study was to evaluate... |
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| SubjectTerms | 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 |
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| Title | Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation： A Randomized Double-blind Study |
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