Dexmedetomidine versus midazolam/propofol or midazolam/ fentanyl for conscious sedation during awake fiberoptic intubation

Background Awake fiberoptic intubation (AFOI) is an established technique for the management ofpatients with difficult airways. A number of drugs have been described to provide sedationfor this procedure. Benzodiazepines combined with opioids or propofol are commonly usedagents. Recently, dexmedetomidine has emerged as an ideal sedative during AFOI. Objectives To compare the efficacy and safety of dexmedetomidine as a sole sedative versus the conventionally used propofol/midazolam and fentanyl/midazolam combinations during AFOI. Patients and methodsSeventy-five patients with anticipated difficult airways who required tracheal intubation for elective surgery were enrolled and randomly allocated to one of three groups: group D (n=25) received a dexmedetomidine infusion, group PM (n=25) received a propofol/ midazolam combination, and group FM (n=25) received a fentanyl/midazolam combination. The main outcome measures were fiberoptic intubating conditions and patient tolerance, which were graded using multiple scoring systems. Other parameters including hemodynamic (mean arterial pressure and heart rate) and respiratory changes were recorded. Results All the scores that quantified patient tolerability and the fiberoptic intubating conditions were significantly better in group D than both groups PM and FM. Mean arterial pressure and heart rate decreased significantly during sedation in group D and group PM. Meanwhile, there was considerable hemodynamic stability in both group D and PM during intubation. The dexmedetomidine group showed more favorable respiratory changes than the other two groups.Conclusion Dexmedetomidine alone appears to be a more suitable agent for sedation during AFOIcompared with either propofol/midazolam or fentanyl/midazolam combinations.