Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.01.005
Brazilian Journal of Anesthesiology
Clinical Research

Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial

Condições para intubação traqueal e alterações hemodinâmicas durante intubação com fibroscopia. Estudo clínico randomizado versus dexmedetomidina

Anil Kumar Verma, Shipra Verma, Amiya Kumar Barik, Vinay Kanaujia, Sangeeta Arya

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Abstract

Background and objectives
: Awake fiberoptic intubation (AFOI) is usually performed in patients with an anticipated difficult airway. Various sedation regimens are used during AFOI, however, most of them cause respiratory depression. The present study aims to compare the effectiveness of fentanyl with ketamine versus dexmedetomidine in search of a better sedation regimen which would achieve desirable intubating conditions and hemodynamic stability without causing respiratory depression.

Methods
This is a single centered randomized, double-blind clinical trial. Patients of both sexes between age 18-55 years and ASA class I-II with an anticipated difficult airway were randomly divided into two groups of thirty each. Group FK patients received intravenous fentanyl and ketamine, and group DX patients received dexmedetomidine, until Ramsay sedation scale ≥ 2. Heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), respiratory rate (RR), endoscopy time, intubation time, first end-tidal carbon dioxide (ETCO2) after intubation, endoscopist satisfaction score, and patient discomfort score were recorded during the study period. The level of recall was assessed on the next postoperative day.

Results
Endoscopist satisfaction score was better in group DX patients (p <  0.05). There was a smaller variation in HR and MBP from baseline with dexmedetomidine compared to fentanyl with ketamine. First ETCO2 after intubation was higher in group FK patients (p <  0.05). No significant difference was found in patient discomfort score, intubation time, RR, SpO2, and level of recall of the event.

Conclusions
The use of dexmedetomidine in AFOI provides better intubating conditions and hemodynamic stability compared to fentanyl with ketamine.

Keywords

Airway management;  Fiberoptic intubation;  Fentanyl;  Ketamine;  Dexmedetomidine

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