Comparison of Intubation Conditions between Dexmedetomidine and Propofol for Awake Fiberoptic Bronchoscopy: A Randomised Control Study

Authors

  •   A. Hemavathi Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka
  •   C. G. S. Prasad Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka
  •   Pradeep A. Dongare Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka
  •   Chandrashekar Manjunatha Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka
  •   Madagondapalli Srinivasan Nataraj Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka
  •   R. M. Mohan Kumar Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka

DOI:

https://doi.org/10.4103/kaj/2019/v17i3-4/158422

Keywords:

Bronchoscopy, Dexmedetomidine, Intubating Conditions, Propofol

Abstract

Introduction: Awake Fiberoptic Intubation (AFOI) is a valuable modality for airway management. Both optimal intubating condition and patient comfort are paramount for fiberoptic intubation. The challenges associated with the procedure are to provide adequate sedation while maintaining patent airway and ventilation. Both dexmedetomidine and propofol provide procedural sedation. Therefore, this study was taken to compare intubating conditions and haemodynamic stability between dexmedetomidine and propofol for Awake Fiberoptic Bronchoscopy. Methods: 60 patients of ASA physical status I or II undergoing elective surgery were enrolled for the study. They were randomly allocated into two groups, group D received dexmedetomidine (1 μg/kg over 10 min followed by infusion) and group P received propofol (1 mg/kg over 10 min followed by infusion). After achieving Ramsay sedation score of ≥2 bronchoscopy was performed. The following parameters were assessed and compared: Intubating conditions were evaluated by intubation score including vocal cord movement, coughing and limb movement. Post intubation condition was assessed by a subjective scale. Haemodynamic parameters were recorded at baseline, end of infusion and post intubation. Other parameters assessed were intubation time, sedation, number of attempts at intubation and any complications during the procedure. Results: Demographics were comparable. Intubating conditions and post intubation scores were comparable. Dexmedetomidine provided better haemodynamic stability at the end of infusion and post intubation (p = 0). Both provided a favorable sedation but propofol provided much deeper mean sedation score compared to dexmedetomidine. Intubation time was shorter in group D (p = 0). Conclusion: Both dexmedetomidine and propofol provide favorable intubation conditions, but dexmedetomidine in addition provides better haemodynamic stability and conscious sedation.

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Published

2019-12-08

How to Cite

Hemavathi, A., Prasad, C. G. S., Dongare, P. A., Manjunatha, C., Srinivasan Nataraj, M., & Mohan Kumar, R. M. (2019). Comparison of Intubation Conditions between Dexmedetomidine and Propofol for Awake Fiberoptic Bronchoscopy: A Randomised Control Study. Karnataka Anaesthesia Journal, 17(3-4), 71–79. https://doi.org/10.4103/kaj/2019/v17i3-4/158422

Issue

Volume 17, Issue 3-4, July-December 2019

Section

Clinical Investigations
Crossref
Scopus
Google Scholar
Europe PMC

References

Cormack RS, Lehane J. Difficult intubation in obstetrics. Anaesthesia. 1984; 39:1105–11. https://doi. org/10.1111/j.1365-2044.1984.tb08932.x.

Wilson ME, Speiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth. 1998; 61:211– 6. PMid: 3415893. https://doi.org/10.1093/bja/61.2.211.

Carin AH, Carlos AA. Airway management in adults. Ronald D Miller Z. Millers anaesthesia. 8th ed. Philadelphia: Elsevier; 2014. 1647–81..

Tsai CJ, Chu KS, Chen TI, Lu DV, Wang HM, Lu IC. A comparison of the effectiveness of dexmedetomidine vs. Propofol target - controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010; 65:254–9. PMid: 20105150. https://doi.org/10.1111/j.1365- 2044.2009.06226.x.

Bergese SD, Bender SP, McSweeney TD, Fernanadez S, Dzwonczyk R, Sage K. A comparative study of Dexmedetomidine with midazolam and with midazolam alone for sedation during elective fibreoptic intubation. J Clin Anesth. 2010; 22:35–40. PMid: 20206849. https://doi. org/10.1016/j.jclinane.2009.02.016.

Lallo A, Billard V, Bourgain JL. A comparison of Propofol and remifentanil target controlled infusions to facilitate fibreoptic nasotracheal intubation. Anesth Analg. 2009; 108:852–7. PMid: 19224793. https://doi.org/10.1213/ ane.0b013e318184eb31.

Zhang X, He W, Wu X, Zhou X, HuangW, Feng X. TCI remifentanil vs. TCI Propofol for awake fiber-optic intubation with limited topical anesthesia. Int J Clin Pharmacol Ther. 2012; 50:10–6. PMid: 22192640. https://doi.org/10.5414/ CP201580.

Chu KS, Wang FY, Hsu HT, Lu IC, Wang HM, Tsai CJ. The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation. Eur J Anaesthesiol. 2010; 27:36–40. PMid: 19550337. https://doi.org/10.1097/EJA.0b013e32832e0d2b.

Rai MR, Parry TM, Dombrovskis A, Warner OJ. Remifentanil target-controlled infusion vs. Propofol target controlled infusion for conscious sedation for awake fiberoptic intubation: A doubleblinded randomized controlled trial. Br J Anaesth. 2008; 100:125–30. PMid: 18037667. https://doi. org/10.1093/bja/aem279.

Gupta K, Jain M, Gupta PK, Rastogi B, Saxena SK, Manngo A. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial. Saudi J Anaesth. 2012; 6:219– 23. PMid: 23162393 PMCid: PMC3498658. https://doi. org/10.4103/1658-354X.101211.

Chalam KS. A comparative study of intravenous dexmedetomidine- versus Propofol-based sedation for Awake Fiberoptic Intubation along with airway blocks in cervical discectomy patients. Karnataka Anaesth J. 2015; 1:21–7. https://doi.org/10.4103/2394-6954.149716.

Kevin DJ, Mridula RR. Conscious sedation for Awake Fibreoptic Intubation: A review of the literature. Can J Anesth. 2013; 60:584–99. PMid: 23512191. https://doi. org/10.1007/s12630-013-9915-9.

Reves JG, Glass P, Lubarsky DA. Intravenous anesthetics. Miller RD. Miller’s anesthesia.7th ed. Philadelphia:Churchill Livingstone; 2010. p. 719–68. https://doi.org/10.1016/ B978-0-443-06959-8.00026-1.

Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2:656–9. PMid: 4835444 PMCid: PMC1613102. https://doi.org/10.1136/bmj.2.5920.656.

Sinha SK, Joshiraj B, Chaudhary L, Hayaran N, Kaur M, Jain A. A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fiberoptic nasotracheal intubation: A randomized controlled study. J Anaesthesiol Clin Pharmacol. 2014; 30:514–9. PMid: 25425777 PMCid: PMC4234788. https://doi. org/10.4103/0970-9185.142846.

Knolle E, Oehmke MJ, Gustorff B, Hellwagner K, Kress HG. Target controlled infusion of Propofol for fiberoptic intubation. Eur J Anaesthesiol. 2003; 20:5659. https://doi. org/10.1097/00003643-200307000-00009.

Avitsian R, Lin J, Lotto M, Ebrahim Z. Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy: A clinical series. J Neurosurg Anesthesiol. 2005; 17:97–9. PMid: 15840996. https://doi.org/10.1097/01. ana.0000161268.01279.ba.

Neumann MM, Davio MB, Macknet MR, Applegate RL 2nd. Dexmedetomidine for Awake Fiberoptic Intubation in a parturient with spinal muscular atrophy type III for cesarean delivery. Int J ObstetAnesth. 2009; 18:403–7. PMid: 19733055. https://doi.org/10.1016/j.ijoa.2009.05.002.

Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A. Comparison between dexmedetomidine and fentanyl on intubation conditions during Awake Fibreoptic Bronchoscopy: A randomized double-blind prospective study. J Anaesthesiol Clin Pharmacol. 2015; 31:212–6. PMid: 25948903 PMCid: PMC4411836. https:// doi.org/10.4103/0970-9185.155151.

Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992; 77:1125–33. PMid: 1361310. https://doi.org/10.1097/00000542-199212000- 00013.

Aantaa R, Jalonen J. Perioperative use of alpha2-adrenoceptor agonists and the cardiac patient. Eur J Anaesthesiol, 2006; 23:361–72. PMid: 16507202. https://doi.org/10.1017/ S0265021506000378