The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation.
OBJECTIVE
Dexmedetomidine is characterized with effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, it should be suitable for awake fibreoptic intubation (AFOI).


METHODS
We enrolled 30 oral cancer patients with limited mouth openings who were undergoing AFOI for elective surgery. Patients were randomly allocated into two groups; the Dex group (n = 16) that received dexmedetomidine (1.0 microg kg(-1)) infusion and the Control group (n = 14) that received fentanyl (1.0 microg kg(-1)) infusion. Main outcomes were evaluated by grading scores presenting conditions for nasal intubation and postintubation. Other analysed parameters included airway obstruction, haemodynamic changes, consumption time for intubation, amnesia level and satisfaction.


RESULTS
Intubation score (1-5) representing condition for nasal intubation was significantly better in the Dex group [2(1-3)] than in the Control group [3(2-5)] (P = 0.001). Postintubation score (1-3) representing tolerance to intubation also showed more favourable results in the Dex group [1(1-3)] than in the Control group [2(2-3)] (P = 0.002). The Dex group showed significantly reduced haemodynamic response to intubation than the Control group. Incidence requiring temporary haemodynamic support was higher in the Dex group but not of significance. Both levels of amnesia and satisfaction score were significant in the Dex group. Other analysed parameters such as consumption time for intubation, airway obstruction score and postoperative adverse events did not differ significantly.


CONCLUSIONS
Combination of dexmedetomidine loading with topical anaesthesia provides significant benefit for AFOI in intubation condition, patient tolerance, haemodynamic response, amnesia and satisfaction. Dexmedetomidine is effective for AFOI in anticipated difficult airway with only minor and temporary haemodynamic adverse effects.
Chu
Koung-Shing
KS
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Wang
Fu-Yuan
FY
Hsu
Hung-Te
HT
Lu
I-Cheng
IC
Wang
Hsun-Mo
HM
Tsai
Cheng-Jing
CJ
D000328:Adult; D000368:Aged; D000647:Amnesia; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005336:Fiber Optic Technology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D017060:Patient Satisfaction
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D005283:Fentanyl