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A Comparative Study of Dexmedetomidine (1 mcg/kg) and Fentanyl (2 mcg/kg) with Dexmedetomidine (1 mcg/kg) Alone for Sedation during Awake Fiberoptic Intubation

R. Prabhavathi, Professor, Dept. of Anesthesiology, Narayana Medical College, Chintha Reddy Palem, Nellore, Andhra Pradesh 524003, India. , Bhoopal Naik V.1 , Prabhavathi R.2 , P. Narasimha Reddy3 , Balaji4 , Abdul Ansari5

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Indian Journal of Anesthesia and Analgesia 5(2):p 317-325, February 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5218.27

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Abstract

Aim of Study: Many drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine in combination with fentanyl and dexmedetomidine alone. Material and Methods: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for maxillo facial surgeries who were randomly allocated into two groups: Group DF received dexmedetomidine 1 mcg/kg along with fentanyl 2 mcg/kg and Group D received dexmedetomidine 1 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 15min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by Incidence of desaturation, cough score and post-intubation score, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups. Results: Cough score <2 was considered as favourable intubation condition, which was achieved in 27 out of 30 patients in Group DF, but only in 5 out of 30 patients in Group D which is statistically significant. (P < 0.0001) Better tolerance score (Score 1) was found in 21 patients of Group DF and only 4 patients in Group D. This difference was also statistically significant (P < 0.0001). higher RSS was achieved in Group DF(3.7±0.79)than in Group D (1.7±0.65) (P < 0.0001). We observed that 8 patients of Group DF and 28 patients in Group D were able to maintain SpO 2 (95%) (P < 0.0001) during the procedure Conclusion: Dexmedetomidine with fentanyl provides good intubation conditions than Dexmedetomidine alone during AFOI.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5218.27

Keywords

Awake Fiber Optic Intubation (AFOI); Dexmedetomidine; Fentanyl; Cough Score; Intubation Conditions. 

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