Dexmedetomidine Sedation for Awake Fiberoptic Intubation of Patients With Difficult Airways Due To Severe Odontogenic Cervicofacial Infections

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

“…The antisialagogue and moderate analgesic properties of dexmedetomidine have been cited as other advantages. 41,42 We identified 19 articles, five RCTs 13,29,43-45 and 14 case reports and case series [46][47][48][49][50][51][52][53][54][55][56][57][58][59] describing the use of dexmedetomidine for AFOI, usually as the sole agent but occasionally in combination with midazolam 43 or ketamine. 60 Although a TCI system for dexmedetomidine has been described for awake intubation, 47 it is generally administered as a slow bolus (usually 1 lgÁkg -1 over 10-20 min) to avoid peak-dose hypertension (which may exacerbate a bradycardia-related fall in cardiac output) followed by an infusion (usually of 0.1-0.7 lgÁkg…”

“…55,56 Nevertheless, the real advantage of a sedative that spares respiratory function may become apparent when the clinician is presented with patients already in or at risk of airway obstruction and/or respiratory failure; yet (not surprisingly), to date, there have been only limited case series dealing with such cases. 46,49,50 Boyd and Sutter reported the safe use of dexmedetomidine for AFOI in two patients with severe submandibular abscesses and impending oropharyngeal obstruction, 49 while Abdelmalak et al reported its safe use in three patients with impending respiratory failure. 50 In cases of critical airway obstruction, avoidance of drugs that depress both conscious level and ventilatory drive, as alluded to above, is recommended.…”

Dexmedetomidine: New avenues

“…Dexmedetomidine provides an ideal solution to this problem especially in critical airways compromised due to anatomical distortions and infections. [56] Series of case reports document efficacy of dexmedetomidine as a sole sedative for awake intubations in managing a critical airway, as a bolus ranging from 0.5 to 1 mcg/kg followed by infusion of 0.2 to 0.7 mcg/kg/hr, with no evidence of respiratory depression. [5758] An unique attempt in this field has been the use of dexmedetomidine without any topicalization for AFOI in a patient with a critical airway who had a true documented allergy to local anesthetics.…”

A randomised comparative study of dexmedetomidine and midazolam for sedation during awake fiberoptic intubation in laproscopic cholecystectomy patients

“…Many agents have been reported to provide sedation for intubation including fentanyl, ketamine, midazolam, remifentanil, propofol, and dexmedetomidine. [1][2][3][4][5] Dexmedetomidine, an α2-adrenoceptor agonist, may be a wondrous drug for use during fiberoptic intubation as it produces sedation and analgesia without concomitant depressing respiratory function. 6,7 Thus, dexmedetomidine possess numerous properties that make it a convenient drug for use in managing patients with difficult airways.…”