Background: Awake fiberoptic endoscope intubation (AFOI) is the primary strategy for managing anticipated difficult airways. Adequate sedation, most commonly being achieved with remifentanil and dexmedetomidine, is integral to this procedure. This meta-analysis aimed to compare the safety and efficacy of these 2 sedatives. Methods: We conducted electronic searches in Embase, Web of Science, PubMed, Google Scholar, Medline, Springer, and Web of Science with no language restrictions. Studies comparing safety and efficacy between the sole use of remifentanil and dexmedetomidine among patients who underwent AFOI were included. Eight randomized controlled trials, comprising 412 patients, met the inclusion criteria. The primary outcomes were first attempt intubation success rate and incidence of hypoxia. The secondary outcomes were the Ramsay Sedation Scale score at intubation, memory recall of endoscopy, and unstable hemodynamic parameters during intubation. Results: Dexmedetomidine significantly reduced the incidence of hypoxemia during AFOI (risk ratio: 2.47; 95% confidence [CI]: 1.32–4.64]) compared with remifentanil; however, the first intubation success rates were equivalent (risk ratio: 1.12; 95% CI: 0.87–1.46]. No significant differences between the 2 sedatives were found for the Ramsay Sedation Scale score at intubation (mean difference: −0.14; 95% CI: −0.66–0.38) or unstable hemodynamic parameters during intubation (risk ratio: 0.83; 95% CI: 0.59–1.17). Dexmedetomidine reduced memory recall of endoscopy (risk ratio: 1.39; 95% CI: 1.13–1.72). Conclusions: While both remifentanil and dexmedetomidine are effective for AFOI and well-tolerated, dexmedetomidine may be more effective in reducing the incidence of hypoxemia and memory recall of endoscopy. PROSPERP registration number: CRD42020169612.
BackgroundOptimal size selection of classic laryngeal mask airway (LMA) remains a major challenge for anaesthesiologists. Because the body weight, current method to select LMA size, might not inconsistent with dimension of hypopharynx where LMA is positioned. Hyomental distance by ultrasound as an common parameter in upper airway may be considered a predictor of LMA size choice, that we conducted a randomized, controlled study to compare the efficacy of size selection between commonly recommended weight-based method and hyomental distance-based method.MethodsSeventy female patients undergoing breast cancer surgery were enrolled in our study and randomly assigned into either the hyomental distance group or weight group. The primary outcome was the correct rate of selection LMA without need for size adjustment or use of other devices. Secondary outcomes included injury rate, oropharyngeal leak pressure (OLP), and insertion attempts.ResultsTwo participants were excluded from weight group due to tracheal intubation. The correct rate of LMA size-selected were significant difference of 77.14% and 51.51% in hyomental distance group and weight group, respectively(P=0.027). Five (14.29%) and 7 (21.21%) patients were injured in hyomental-distance group and weight group, respectively. Values of OLP in two groups were 22 (19-24) cmH2O and 22 (19.5-24) cmH2O, respectively. The insertion attempts were the same in both groups and no statistical differences were observed regarding these three outcomes. ConclusionThe hyomental distance-based method possessed a higher success rate for LMA-classic size selection than did the weight-based method, with the same excellent OLP value, low possibility of injury, and a low number of insertion attempts as weight-based method. Trial registrationOur study was registered with the Chinese Clinical Trial Registry (ChiCTR1900021123), registered 29 January 2019.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.