A comparison of the effectiveness of dexmedetomidine versus propofol target‐controlled infusion for sedation during fibreoptic nasotracheal intubation

Abstract

SummaryFibreoptic intubation is a valuable modality for airway management. This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 lg.kg in the propofol group (p = 0.027), favouring the former. The dexmedetomidine group experienced fewer airway events and less heart rate response to intubation than the propofol group (p < 0.003 and p = 0.007, respectively). Both dexmedetomidine and propofol target-controlled infusion are effective for fibreoptic intubation. Dexmedetomidine allows better tolerance, more stable haemodynamic status and preserves a patent airway.

Conscious sedation for awake fibreoptic intubation: a review of the literature

“…None recalled the tracheal intubation, but they were uncooperative at the end, and immediate progression to general anesthesia was necessary in every instance. 13 Airway obstruction was more frequent with propofol than with dexmedetomidine, as was the increase in heart rate in response to tracheal intubation. An even higher average (standard deviation) propofol concentration of 3.9 (1.4) lgÁmL -1 was used by Lallo et al who successfully intubated the tracheas of 29/30 similarly topicalized patients.…”

“…9 A greater body of published work has focused on targetcontrolled infusion (TCI) of propofol for AFOI, either as the sole agent or in combination with remifentanil. [10][11][12][13] Targetcontrolled infusions of propofol for AFOI have been assessed in three RCTs providing level 1 evidence comparing it with remifentanil (Table 2) 10-12 and in one RCT comparing it with dexmedetomidine. 13 In the propofol arm of the randomized trial by Rai et al, the tracheas of 9/10 patients were successfully intubated at the first attempt after SAYGO topicalization.…”

“…Tsai et al randomized 40 patients needing AFOI to either dexmedetomidine (1.0 lgÁkg -1 ) or propofol TCI (effect-site concentration 3.6 lgÁmL -1 ) (see above and Table 2). Both drugs provided satisfactory intubating conditions; however, patients in the dexmedetomidine (DEX) group had less discomfort, heart rate changes, and episodes of airway obstruction 13 . Hagberg et al randomized 30 patients with ''expected difficult airways'' to either a dexmedetomidine bolus of 0.4 lgÁkg -1 followed by an infusion at a rate of 0.7 lgÁkg -1 Áhr -1 or a remifentanil bolus 0.75 lgÁkg -1 followed by an infusion at a rate of 0.075 lgÁkg -1 Ámin -1 .…”

Comparison of dexmedetomidine combined with propofol Vs fentanyl combined with propofol for laryngeal mask insertion

“…[18][19][20] The  2 -adrenoceptors exert their sedative effects, via the recepto rs in locus coeruleus. Dexmedetomidine, even when used at supramaximal plasma levels, has been found to be clinically safe for respiration.…”

Znieczulenie miejscowe do intubacji w systemie awake intubation za pomocą wideolaryngoskopu Truview PCD

“…Compared to remifentanil [21] or propofol [22], dexmedetomidine provides better conditions for intubation and greater comfort for the patient.…”