Vishnoi Gunjan, Shah Shagun B, Chawla Rajiv, Bhardwaj Manoj, Patel Anil, Arora Jenna
Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.
Indian J Anaesth. 2024 Aug;68(8):699-705. doi: 10.4103/ija.ija_923_23. Epub 2024 Jul 2.
Awake intubation is the preferred method for securing difficult airways. We compared intravenous (IV) propofol and dexmedetomidine for C-MAC D-blade-guided anticipated difficult nasotracheal intubation under conscious sedation.
This randomised study included 60 patients with difficult airway (El-Ganzouri Score 4-9). After adequate airway preparation with IV midazolam 0.03 mg/kg and IV fentanyl 1 µg/kg, in Group P, propofol was infused at 250 µg/kgmin and in Group D, dexmedetomidine was infused at 1 μg/kg over 10 min, then at 0.5 μgkgh till a bispectral index (BIS) value 65-70 was achieved. Patients underwent C-MAC D-blade video laryngoscope-guided nasotracheal intubation. The intubation score was the primary outcome measure. Secondary outcome measures included haemodynamic parameters, intubation time, number of attempts, the incidence of failed awake intubation, glottic view, time to achieve desired BIS, complications, study drug consumption and patient-reported satisfaction with the awake intubation technique. Quantitative variables were compared between groups using unpaired -test/Welsch test/Mann-Whitney Test. Qualitative variables were correlated using the Chi-square test/Fisher's exact test. A value of <0.05 was considered statistically significant.
The intubation score was significantly higher in Group D versus Group P ( = 0.007). Patient reaction to intubation, haemodynamic parameters and percentage of glottis opening score were more favourable in Group P. Coughing and vocal cord movement were comparable between the groups ( > 0.05). The time to target BIS was four times longer, and the time to intubate was 6 seconds longer in Group D.
Successful awake C-MAC D-blade video laryngoscopic intubation can be performed under dexmedetomidine/propofol conscious sedation, with propofol giving a better intubation score.
清醒插管是确保困难气道安全的首选方法。我们比较了静脉注射丙泊酚和右美托咪定用于在清醒镇静下经C-MAC D型喉镜引导下预计困难的鼻气管插管。
这项随机研究纳入了60例困难气道患者（El-Ganzouri评分4-9分）。在静脉注射0.03mg/kg咪达唑仑和1μg/kg芬太尼进行充分气道准备后，P组以250μg/kg·min的速度输注丙泊酚，D组在10分钟内静脉注射1μg/kg右美托咪定，然后以0.5μg/kg·h的速度输注，直至双谱指数（BIS）值达到65-70。患者接受C-MAC D型喉镜视频引导下的鼻气管插管。插管评分是主要观察指标。次要观察指标包括血流动力学参数、插管时间、尝试次数、清醒插管失败发生率、声门视野、达到所需BIS的时间、并发症、研究药物消耗量以及患者报告的对清醒插管技术的满意度。使用不成对t检验/威尔士检验/曼-惠特尼检验比较组间定量变量。使用卡方检验/费舍尔精确检验关联定性变量。P值<0.05被认为具有统计学意义。
D组的插管评分显著高于P组（P = 0.007）。P组患者对插管的反应、血流动力学参数和声门开口评分百分比更有利。两组间咳嗽和声带运动情况相当（P>0.05）。D组达到目标BIS的时间长四倍，插管时间长6秒。
在右美托咪定/丙泊酚清醒镇静下可成功进行清醒的C-MAC D型喉镜视频插管，丙泊酚的插管评分更佳。
