Comparison of Dexmedetomidine vs Midazolam for Sedation during Awake Fiberoptic Intubation - A Randomised Interventional Study in Oral Cancer Surgeries

Abstract

Background and Aims: Fiberoptic nasotracheal intubation is an effective method for the management of patients with difficult airways. Optimal intubating conditions and patient comfort are important while preparing the patient for fiberoptic intubation. The aim of this study is to compare Dexmedetomidine and Midazolam for sedation during awake fiberoptic intubation in oral cancer surgeries. Methods: Patients were randomly allocated into two groups. Each consisted of 30 patients. Group 1 (MDZ) Subjects received IV Midazolam 0.05mg/kg bolus in 10ml normal saline over 10 minutes followed by infusion at the rate of 0.1mg/kg/hr titrated upto 0.2mg/kg/hr to achieve a RSS≥2. Group 2(DEX) Subjects received IV Dexmedetomididne 1μg/kg bolus in 10ml normal saline over 10 minutes followed by infusion at the rate of 0.2μg/kg/hr titrated upto 0.7μg/kg/hr to achieve a RSS≥2. Comfort Scale values, hemodynamic parameters and patient’s tolerance was observed. 24 hours after the surgery patient’s satisfaction was assessed with a questionnaire. Results: The demographic data, systolic and diastolic blood pressures and O2 saturation were comparable. Significant change in heart rate was observed in group MDZ while heart rate was stable in DEX group (p<0.01). Group DEX patients were more comfortable with comfort score <20 and had greater endurance with tolerance score <2.5 compared to MDZ group (>20/>2.5, p<0.01) and had an acceptable level of sedation. After 24 hours DEX group patients judged their sedation more positively than MDZ group with a score (6.16 vs. 3.6). Conclusions: Both Midazolam and Dexmedetomidine are effective for awake fiberoptic intubation. But Dexmedetomidine provided better patient comfort and satisfaction along with stable hemodynamics.