Comparison of Dexmedetomidine and Nalbuphine on Intubating Conditions and Hemodynamic Responses During Awake Fiberoptic Intubation: A Randomized Study

Sujata Chaudhary; R C Ananth; Swati Bharti; Rashmi Salhotra; Mahendra Kumar

doi:10.18502/aacc.v9i5.13955

Sujata Chaudhary Department of Anesthesiology and Intensive Care, VMM College and SJ Hospital, IP University, Delhi, India.
R C Ananth Department of Critical Care Medicine, Manipal Hospitals, Bengaluru, India.
Swati Bharti Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, JPNATC, Delhi, India.
Rashmi Salhotra Department of Anesthesiology and Critical Care, UCMS and GTB Hospital, Delhi University, Delhi, India.
Mahendra Kumar Department of Anesthesiology and Critical Care, Sharda Medical School and Research (SMSR), Sharda University, Greater Noida, UP, India.

DOI: https://doi.org/10.18502/aacc.v9i5.13955

Keywords: Airway management; Awake fiberoptic intubation; Dexmedetomidine; Difficult airway; Nalbuphine

Abstract

Background: The pre-requisites to a successful awake fiberoptic intubation (AFOI) include adequate psychological and pharmacological preparation of the patient. This study aims to compare two pharmacological agents, dexmedetomidine and nalbuphine, in addition to nebulization and airway topicalization, for intubating conditions during AFOI.

Methods: Sixty consenting patients belonging to ASA I/II, MPC I/II, age-group of 18-60 years weighing between 40-70 kgs requiring general anaesthesia with endotracheal intubation were randomly allocated to one of the two groups. Patients received dexmedetomidine 1µg/kg i.v. (group D) or nalbuphine 0.2 mg/kg i.v. (group N) over 10 min before intubation. Fiberoptic intubation was attempted. Intubating conditions were assessed in terms of sedation score, cough score and post-intubation score. Hemodynamic responses, lignocaine and propofol requirement were also recorded. Repeated measure ANOVA, Tukey’s test, unpaired t test, Chi‑square test or Fisher’s exact test were used for data analysis. A P < 0.05 was considered significant.

Results: Sedation score (P = 1.000), cough score (P = 0.165) and post‑intubation score (P = 0.157) were comparable among the two groups. Hemodynamic responses, propofol and lignocaine requirements were also comparable.

Conclusion: Both intravenous dexmedetomidine and nalbuphine provide good intubating condition with minimal adverse effects on haemodynamic profile during awake fibreoptic intubation.