title: Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients.
abstract: OBJECTIVE
  We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients.
  
  
  METHODS
  In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX. After locally anesthetizing the airway and applying a cervical collar, patients either received DEX 1 μg/kg over 10 min followed by 0.7 μg/kg/h maintenance infusion or normal saline in the same dose and rate during AFOI. Targeted sedation (Ramsay sedation score [RSS] ≥2) during AFOI was maintained with midazolam [MDZ] in both groups. Statistical Analysis was performed using unpaired Student's t-test, Chi-square test, Mann-Whitney test and Wilcoxon-w test.
  
  
  RESULTS
  The total number of patients requiring MDZ and the mean dose of MDZ required to achieve targeted sedation (RSS ≥2) was significantly less in DEX group compared to the placebo group (P < 0.001). Similarly, patient satisfaction score, heart rate, systolic, diastolic and mean arterial pressure and respiratory parameters were significantly better in DEX group (P < 0.001). Postintubation arousability in the two groups was comparable (P = 0.29).
  
  
  CONCLUSIONS
  Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment.
authors.affiliation: Department of Anesthesia and Intensive Care, Hindu Rao Hospital, New Delhi, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Chopra
authors.affiliation: Department of Anesthesia and Intensive Care, Hindu Rao Hospital, New Delhi, India.
authors.forename: Madhu Bala
authors.initials: MB
authors.lastname: Dixit
authors.affiliation: Department of Anesthesia and Intensive Care, Hindu Rao Hospital, New Delhi, India.
authors.forename: Aashish
authors.initials: A
authors.lastname: Dang
authors.affiliation: Department of Anesthesia and Intensive Care, Hindu Rao Hospital, New Delhi, India.
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Gupta
keywords: Awake fiberoptic intubation; cervical spine injury; dexmedetomidine