title: A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fiberoptic nasotracheal intubation: A randomized controlled study.
abstract: OBJECTIVE
  We designed a study to compare the effectiveness of dexmedetomidine plus ketamine combination with dexmedetomidine alone in search of an ideal sedation regime, which would achieve better intubating conditions, hemodynamic stability, and sedation for awake fiberoptic nasotracheal intubation.
  
  
  METHODS
  A total of 60 adult patients of age group 18-60 years with American Society of Anesthesiologists I and II posted for elective surgery under general anesthesia were randomly divided into two groups of 30 each in this prospective randomized controlled double-blinded study. Groups I and II patients received a bolus dose of dexmedetomidine at 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. Upon completion of the dexmedetomidine bolus, Group I patients received 15 mg of ketamine and an infusion of ketamine at 20 mg/h followed by awake fiberoptic nasotracheal intubation, while Group II patients upon completion of dexmedetomidine bolus received plain normal saline instead of ketamine. Hemodynamic variables like heart rate (HR) and mean arterial pressure (MAP), oxygen saturation, electrocardiogram changes, sedation score (modified Observer assessment of alertness/sedation score), intubation score (vocal cord movement and coughing), grimace score, time taken for intubation, amount of lignocaine used were noted during the course of study. Patient satisfaction score and level of recall were assessed during the postoperative visit the next day.
  
  
  RESULTS
  Group I patients maintained a stable HR and MAP (<10% fall when compared with the baseline value). Sedation score (3.47 vs. 3.93) and patient satisfaction score were better in Group I patients. There was no significant difference in intubation scores, grimace scores, oxygen saturation and level of recall when compared between the two groups (P > 0.05).
  
  
  CONCLUSIONS
  The use of dexmedetomidine plus ketamine combination in awake fiberoptic nasotracheal intubation provided better hemodynamic stability and sedation than dexmedetomidine alone.
authors.affiliation: Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Bandi
authors.initials: B
authors.lastname: Joshiraj
authors.affiliation: Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Lalita
authors.initials: L
authors.lastname: Chaudhary
authors.affiliation: Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Hayaran
authors.affiliation: Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Aruna
authors.initials: A
authors.lastname: Jain
keywords: Awake; bronchoscopy; dexmedetomidine; fiberoptic; ketamine; sedation