Karnataka Anaesthesia Journal

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


Affiliations
1 Department of Anesthesiology and Critical care, ESIC-PGIMSR, Rajajinagar, Bangalore – 560010, Karnataka, India
 

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.

Keywords

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

Abstract Views: 73  |  PDF Views: 63

Authors

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

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.

Keywords


Bronchoscopy, Dexmedetomidine, Intubating Conditions, Propofol

References