| Awake fiberoptic intubation (AFOI) is usually performed in the management of the anticipated difficult airway. The aim of
this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and fentanyl with midazolam (FM)
for sedationfor awake fiberoptic nasotracheal intubation. Fifty patients with restricted mouth opening scheduled for AFOI
were randomly assigned to two groups (n = 25 per group). 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 ?g/kg over 10 min followedby a continuous infusion of 0.25 ?g/kg/h, whereas Group FM received
fentanyl at a loading dose of 2 ?g/kg over 10 min followed by a continuous infusion of 1 ?g/kg/h. 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. 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 CO2 after intubation was higher in Group FM than that in Group DM
(45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P < 0.05). Both dexmedetomidine and fentanyl are effective as an
adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is a
potential risk in the fentanyl regimen.ddd |
