Yadav Urvashi, Yadav Jay Brijesh Singh, Srivastava Dhiraj, Srivastava Swati
Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.
Department of Social and Preventive Medicine, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.
Anesth Essays Res. 2020 Apr-Jun;14(2):271-276. doi: 10.4103/aer.AER_44_20. Epub 2020 Oct 12.
Awake fibreoptic nasotracheal intubation is an effective technique for the management of patients with difficult airways. Adequate sedation with effective topicalization of the airway is important to overcome discomfort and achieve intubation successfully.
Our aim was to compare the effectiveness of dexmedetomidine-midazolam with fentanyl-midazolam infusion for providing conscious sedation during fibreoptic intubation in patients with anticipated difficult airway under topical anaesthesia.
Thirty adult patients of ASA physical status classification I and II with anticipated difficult airway and planned for elective awake nasal fibreoptic intubation under conscious sedation were randomly allocated into two groups. Dexmedetomidine 1 μg.kg-1 diluted in 50 ml saline was infused in Group DM over 10 min and Fentanyl 2 μg.kg-1 diluted in 50 ml saline was infused in Group FM over 10 min. Topicalization of the airway was done in all patients. All patients were assessed for sedation score, ease of endotracheal tube placement, patient comfort and cooperation, tolerance to endotracheal tube, any adverse events and recall of procedure.
The score of the modified OAA/S was comparable between the groups ( > 0.05). Quality of AFOI was comparable in both groups ( > 0.05). The intubation time and first EtCO2 were significantly lower in dexmedetomidine group ( <0.05). Group DM also showed better hemodynamics and less episodes of desaturation than Group FM.
Fentanyl-midazolam and dexmedetomidine-midazolam are both effective for awake fiberoptic intubation under topical anesthesia. Dexmedetomidine allows better endurance and more stable hemodynamics.
清醒纤维光导鼻气管插管是处理困难气道患者的一种有效技术。充分镇静并有效实施气道表面麻醉对于克服不适并成功完成插管很重要。
我们的目的是比较右美托咪定 - 咪达唑仑与芬太尼 - 咪达唑仑输注用于在局部麻醉下对预期有困难气道的患者进行纤维光导插管时提供清醒镇静的有效性。
30例美国麻醉医师协会（ASA）身体状况分级为I级和II级、预期有困难气道且计划在清醒镇静下进行择期清醒鼻纤维光导插管的成年患者被随机分为两组。DM组在10分钟内输注稀释于50 ml盐水中的右美托咪定1 μg.kg-1，FM组在10分钟内输注稀释于50 ml盐水中的芬太尼2 μg.kg-1。所有患者均进行气道表面麻醉。评估所有患者的镇静评分、气管导管置入的难易程度、患者舒适度与合作程度、对气管导管的耐受性、任何不良事件以及对操作过程的回忆。
两组间改良的清醒镇静评分（OAA/S）相当（P>0.05）。两组纤维光导插管的质量相当（P>0.05）。右美托咪定组的插管时间和首次呼气末二氧化碳分压（EtCO2）显著更低（P<0.05）。DM组的血流动力学也比FM组更好，且去饱和发作次数更少。
芬太尼 - 咪达唑仑和右美托咪定 - 咪达唑仑在局部麻醉下进行清醒纤维光导插管时均有效。右美托咪定耐受性更好，血流动力学更稳定。
