title: Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study.
abstract: BACKGROUND
  Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation.
  
  
  METHODS
  Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified "spray-as-you-go" technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg-1·h-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers' Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed.
  
  
  RESULTS
  The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P < 0.05).
  
  
  CONCLUSIONS
  Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.
authors.affiliation: Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011, China.
authors.forename: Cheng-Wen
authors.initials: CW
authors.lastname: Li
authors.forename: Yan-Dong
authors.initials: YD
authors.lastname: Li
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Tian
authors.forename: Xian-Gang
authors.initials: XG
authors.lastname: Kong
authors.forename: Kui
authors.initials: K
authors.lastname: Chen
mesh_terms: D000328:Adult; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D017409:Sufentanil / Q000009:adverse effects / Q000627:therapeutic use*; D014851:Wakefulness
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D017409:Sufentanil; D008874:Midazolam