Comparison of Intubating Conditions using Fentanyl plus Propofol Versus Fentanyl plus Midazolam during Fiberoptic Laryngoscopy

Abstract

Introduction: Awake nasal or oral flexible fiberoptic intubation is the airway management technique of choice in known or anticipated difficult airway, unstable cervical fracture, limited mouth opening (as in temporomandibular joint disease), mandibular-maxillary fixation and severe facial burns. Both optimal intubating condition and patient comfort are important for fiberoptic intubation. Optimal intubating conditions provided by an ideal sedation regimen would ensure haemodynamic stability, patient comfort, attenuation of airway reflexes and amnesia. Aim:To compare the intubating conditions using fentanyl plus propofol versus fentanyl plus midazolam during fiberoptic laryngoscopy.

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

“…Dexmedetomidine is usually used at 1 µg/kg over 10 min as a loading dose with or without a maintenance dose of 0.3 µg/kg/h to 0.7 µg/kg/h [9,[21][22][23][24][25][26]. Considering that we combined dexmedetomidine with other anesthetics, we finally chose a loading dose of 1 µg/kg infused intravenously over 10 min with no continuous infusion.…”

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

“…The three anesthetics used in our study all acted quickly when administered intravenously with strong sedation and analgesia effects. Dexmedetomidine is often used at 1 μg/kg over 10 min as a loading dose with or without a maintenance dose of 0.3 μg/kg/h to 0.7 μg/kg/h [9,[23][24][25][26][27][28] in clinical scenarios. For the purpose of the present study, a loading dose of 1 μg/kg of DEX was infused intravenously over 10 min with no continuous infusion, considering that dexmedetomidine was given in combination with other anesthetics.…”

Awake fiberoptic nasotracheal intubation for patients with difficult airway

“…In clinical practice, we have successfully performed sufficient airway anesthesia with a total dose of lidocaine of 60 mg. Therefore, we could perform awake nasotracheal intubation using lower doses of midazolam and fentanyl compared with previous reports [ 2 7 8 ].…”

“…Midazolam is a classic sedative, and is a short-acting benzodiazepine derivative. It has anxiolytic and sedative properties [ 6 7 8 ]. While midazolam is believed to cause minimal hemodynamic effects, it does have the potential to cause loss of airway reflexes.…”

“…Opioids are potent analgesics and can help attenuate coughing and hemodynamic changes. Fentanyl is a short-acting opioid that quickly provides analgesia, mild sedation and analgesia with hemodynamic stability, all of which are beneficial for awake intubation; however, there is a risk for respiratory depression [ 7 8 ]. Because the use of fentanyl alone fails to provide sufficient sedation, midazolam is added in clinical practice to improve the quality of sedation.…”