A comparison of the effectiveness of dexmedetomidine infusion and midazolam for sedating cardiac patients undergoing awake fibreoptic nasal intubation

Fiberoptic intubation is indicated method for difficult airway management. Optimal intubating condition with sedation and patient comfort are important factor for fiberoptic nasal intubation. Titration between sedation and respiratory depression with usual drugs are difficult. It should provide patient comfort and cooperation, spontaneous respiration without airway obstruction, depression of airway reflexes, haemodynamic stability and amnesia.

Dexmedetomidine (α2- adrenoceptor agonist) is a new drug with sedative, analgesic and amnesic properties with minimal respiratory depression and can be easily titrated by infusion. We evaluated the efficacy of this drug and compared it with midazolam in patients with normal airways undergoing cardiac surgery.

47 patients with normal airways who were to undergo awake Fiberoptic intubation were enrolled in this study. The patients were randomly assigned two groups: the first group (n=25) received Dexmedetomidine (1 mcg/kg infusion over 5 minutes) and the control group (n=22) received Midazolam (0.05 mg/kg intravenously). The pulse rate, blood pressure, Oxygen saturations and respiratory rate were monitored after 5 min, during and after intubation. The intubation success was 100% in both groups. Post procedure patient satisfaction and comfort was assessed by a Comfort scale.

In this study of patients undergoing Cardiac surgery with normal airways we found that patients treated with Dexmedetomidine had better hemodynamic safety with regard to blood pressure and heart rate and the depth of respiration and the oxygen saturations were also stable throughout the procedure. Post procedure satisfaction was better with Dexmedetomidine (14 vs 22, P<0.0001). There were no significant adverse events in both groups.

Dexmedetomidine provided beneficial effects in patients undergoing awake Fiberoptic intubation when compared to Midazolam. It allowed better hemodynamic support and comfort levels during the procedure.