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A Comparative Study of Midazolam Alone or in Combination with Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation.
Anesth Essays Res 2019 Jul-Sep; 13(3):539-546AE

Abstract

Background

Awake fiberoptic intubation (AFOI) is the gold standard technique for managing patients with anticipated difficult airway. Conscious sedation is desirable, not only to make the procedure more tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Ideal sedation regime for AFOI should provide comfort, cooperation, hemodynamic stability, and amnesia along with maintenance of spontaneous respiration. Several sedative agents have been assessed over the past two decades for this purpose but α2 agonists appear to be the favorable choice owing to its sedative, analgesic, amnestic, and sympatholytic properties along with good hemodynamic profile.

Aims

The present study has been aimed to recognize the characteristics of dexmedetomidine, clonidine, and midazolam and to compare their efficacy in providing optimal intubating conditions as well as hemodynamic stability during AFOI.

Settings and Design

A prospective double-blind randomized study done in tertiary care hospital.

Materials and Methods

Sixty patients of American Society of Anesthesiologists physical status Classes I and II aged 18-60 years with anticipated difficult airway were randomly allocated into three groups. All the patients received injection midazolam bolus followed by sedation infusion of midazolam, dexmedetomidine, and clonidine according to the allocated group. Primary outcome includes the time to achieve Ramsay Sedation Score (RSS) ≥2, time taken in intubation, intubation score, comfort score for fiberoptic insertion and intubation, and patient tolerance after intubation. The secondary outcome was hemodynamic, and respiratory variables include changes in heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and respiratory rate during the procedure.

Statistical Analysis

All data were recorded, summarized, tabulated, and statistically analyzed using SPSS 16.0 version (Chicago, Inc., USA). The data were presented in mean ± standard deviation. P < 0.05 was considered as statistically significant.

Results

All the three groups were comparable in terms of demographic profile. Time to achieve RSS ≥2 and mean intubation time was significantly less in Groups D and C as compared to Group M (P < 0.001). Among groups, Group D took least time to achieve RSS ≥2 (5.53 ± 0.74) and mean intubation time (4.53 ± 0.91). Similarly, overall intubation score, comfort, and patient tolerance score were significantly more in Group M as compared to Groups D and C (P < 0.001). Among the groups, Group D achieved least intubation score (3.80 ± 0.67) and comfort score (2.53 ± 0.74). Although Groups D and C have a lower mean HR and MAP during the procedure and intubation compared to Group M, the incidence of SpO2 is most frequent with clonidine.

Conclusions

Patients who received α2 agonist were calmer and cooperative with less pain and discomfort than the patients who received midazolam. Dexmedetomidine allows better endurance, stable hemodynamics, and patent airway as compared to clonidine.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.Department of Anesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.Department of Anesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31602075

Citation

Bano, Noor, et al. "A Comparative Study of Midazolam Alone or in Combination With Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation." Anesthesia, Essays and Researches, vol. 13, no. 3, 2019, pp. 539-546.
Bano N, Singh P, Singh D, et al. A Comparative Study of Midazolam Alone or in Combination with Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation. Anesth Essays Res. 2019;13(3):539-546.
Bano, N., Singh, P., Singh, D., & Prabhakar, T. (2019). A Comparative Study of Midazolam Alone or in Combination with Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation. Anesthesia, Essays and Researches, 13(3), pp. 539-546. doi:10.4103/aer.AER_64_19.
Bano N, et al. A Comparative Study of Midazolam Alone or in Combination With Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation. Anesth Essays Res. 2019;13(3):539-546. PubMed PMID: 31602075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Comparative Study of Midazolam Alone or in Combination with Dexmedetomidine or Clonidine for Awake Fiberoptic Intubation. AU - Bano,Noor, AU - Singh,Pooja, AU - Singh,Dheer, AU - Prabhakar,Tallamraju, PY - 2019/10/12/entrez PY - 2019/10/12/pubmed PY - 2019/10/12/medline KW - Awake fiberoptic intubation KW - clonidine KW - conscious sedation KW - dexmedetomidine KW - midazolam SP - 539 EP - 546 JF - Anesthesia, essays and researches JO - Anesth Essays Res VL - 13 IS - 3 N2 - Background: Awake fiberoptic intubation (AFOI) is the gold standard technique for managing patients with anticipated difficult airway. Conscious sedation is desirable, not only to make the procedure more tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Ideal sedation regime for AFOI should provide comfort, cooperation, hemodynamic stability, and amnesia along with maintenance of spontaneous respiration. Several sedative agents have been assessed over the past two decades for this purpose but α2 agonists appear to be the favorable choice owing to its sedative, analgesic, amnestic, and sympatholytic properties along with good hemodynamic profile. Aims: The present study has been aimed to recognize the characteristics of dexmedetomidine, clonidine, and midazolam and to compare their efficacy in providing optimal intubating conditions as well as hemodynamic stability during AFOI. Settings and Design: A prospective double-blind randomized study done in tertiary care hospital. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status Classes I and II aged 18-60 years with anticipated difficult airway were randomly allocated into three groups. All the patients received injection midazolam bolus followed by sedation infusion of midazolam, dexmedetomidine, and clonidine according to the allocated group. Primary outcome includes the time to achieve Ramsay Sedation Score (RSS) ≥2, time taken in intubation, intubation score, comfort score for fiberoptic insertion and intubation, and patient tolerance after intubation. The secondary outcome was hemodynamic, and respiratory variables include changes in heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and respiratory rate during the procedure. Statistical Analysis: All data were recorded, summarized, tabulated, and statistically analyzed using SPSS 16.0 version (Chicago, Inc., USA). The data were presented in mean ± standard deviation. P < 0.05 was considered as statistically significant. Results: All the three groups were comparable in terms of demographic profile. Time to achieve RSS ≥2 and mean intubation time was significantly less in Groups D and C as compared to Group M (P < 0.001). Among groups, Group D took least time to achieve RSS ≥2 (5.53 ± 0.74) and mean intubation time (4.53 ± 0.91). Similarly, overall intubation score, comfort, and patient tolerance score were significantly more in Group M as compared to Groups D and C (P < 0.001). Among the groups, Group D achieved least intubation score (3.80 ± 0.67) and comfort score (2.53 ± 0.74). Although Groups D and C have a lower mean HR and MAP during the procedure and intubation compared to Group M, the incidence of SpO2 is most frequent with clonidine. Conclusions: Patients who received α2 agonist were calmer and cooperative with less pain and discomfort than the patients who received midazolam. Dexmedetomidine allows better endurance, stable hemodynamics, and patent airway as compared to clonidine. SN - 0259-1162 UR - https://www.unboundmedicine.com/medline/citation/31602075/A_Comparative_Study_of_Midazolam_Alone_or_in_Combination_with_Dexmedetomidine_or_Clonidine_for_Awake_Fiberoptic_Intubation L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31602075/ DB - PRIME DP - Unbound Medicine ER -