Chaudhary Sujata, Chaudhary Sachin, Kumar Mahendra, Salhotra Rashmi
Department of Anesthesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India.
J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):378-382. doi: 10.4103/joacp.JOACP_359_19. Epub 2021 Oct 12.
Patient cooperation, sedation, anxiolysis, and topicalization are important prerequisites for the successful and safe conduct of awake intubation. Because of the pharmacological properties, opioids can facilitate this process. Fentanyl is an opioid agonist and nalbuphine is an agonist-antagonist. This study aims to compare these two opioids for their effect on sedation and intubating conditions during awake fiberoptic intubation.
This randomized double-blind controlled study was conducted on 62 ASA I/II patients of either sex between the age of 20 and 60 years, weight between 40 and 80 kg, with MP class I/II airways requiring general anesthesia with endotracheal intubation. All patients received standard airway topicalization and nebulization. Patients were randomly allocated to one of the two groups according to a computer-generated random number table. Group F ( = 31) received fentanyl 2 μg/kg i.v. and group N ( = 31) received nalbuphine 0.2 mg/kg i.v. over 10 min before intubation. Fiberoptic intubation was attempted and lignocaine spray and propofol boluses were administered as and when required. Hemodynamic responses and intubating conditions were recorded. Repeated measure ANOVA, McNemar test, and Chi-square test or Fischer's exact test were used for data analysis. A < 0.05 was considered significant.
Cough score ( = 0.458), post-intubation score ( = 1.000), and sedation score ( = 1.000) were comparable among the two groups. Hemodynamic responses and propofol and lignocaine requirements were also comparable.
Both fentanyl and nalbuphine provide comparable intubating conditions when used before awake fiberoptic intubation with minimal adverse effects on hemodynamic profile.
患者的配合、镇静、抗焦虑及表面麻醉是清醒插管成功与安全实施的重要前提。由于药理特性，阿片类药物可促进这一过程。芬太尼是一种阿片类激动剂，纳布啡是一种激动 - 拮抗型药物。本研究旨在比较这两种阿片类药物在清醒纤维支气管镜插管期间对镇静及插管条件的影响。
本随机双盲对照研究纳入了62例年龄在20至60岁之间、体重在40至80 kg之间、气道分级为MP I/II级、需要全身麻醉下行气管插管的ASA I/II级患者，性别不限。所有患者均接受标准的气道表面麻醉和雾化。根据计算机生成的随机数字表，将患者随机分为两组。F组（n = 31）在插管前10分钟静脉注射芬太尼2 μg/kg，N组（n = 31）在插管前10分钟静脉注射纳布啡0.2 mg/kg。尝试进行纤维支气管镜插管，并根据需要给予利多卡因喷雾和丙泊酚推注。记录血流动力学反应和插管条件。采用重复测量方差分析、McNemar检验、卡方检验或Fisher精确检验进行数据分析。P < 0.05被认为具有统计学意义。
两组间咳嗽评分（P = 0.458）、插管后评分（P = 1.000）和镇静评分（P = 1.000）相当。血流动力学反应以及丙泊酚和利多卡因的用量也相当。
在清醒纤维支气管镜插管前使用时，芬太尼和纳布啡均可提供相当的插管条件，且对血流动力学影响极小。
