Comparison of Dexmedetomidine and Nalbuphine on Intubating Conditions and Hemodynamic Responses During Awake Fiberoptic Intubation: A Randomized Study
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.
[2] Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A. Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study. J Anaesthesiol Clin Pharmacol. 2015; 31:212-6.
[3] Vuyk J, Sitsen E, Reekers M. Intravenous Anaesthetics. In: Miller RD, editor. Miller’s Anaesthesia, 8th edition. Philadelphia: Elsevier Saunders; 2015:821-63.
[4] Nallam SR, Chiruvella S, Reddy A. Monitored anaesthesia care – Comparison of nalbuphine/dexmedetomidine versus nalbuphine/propofol for middle ear surgeries: A double blind randomized trial. Indian J Anaesth. 2017; 61:61 7.
[5] Chaudhary S, Chaudhary S, Kumar M, Salhotra R. Fentanyl versus nalbuphine for intubating conditions during awake fiberoptic bronchoscopy: A randomized double-blind comparative study. J Anaesthesiol Clin Pharmacol. 2021; 37:378-82.
[6] Ebert T, Maze M. Dexmedetomidine: Another arrow for the clinician's quiver. Anesthesiology. 2004; 101:568–70.
[7] Abdelmalak B, Makary L, Hoban J, Doyle DJ. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. J Clin Anesth. 2007; 19:370–3.
[8] Maroof M, Khan RM, Jain D, Ashraf M. Dexmedetomidine is a useful adjunct for awake intubation. Can J Anaesth. 2005; 52:776–7.
[9] Bergese SD, Candiotti KA, Bokesch PM, Zura A, Wisemandle W, Bekker AY, et al. A phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation. Am J Ther. 2010; 17:586–95.
[10] Yousuf A, Ahad B, Mir AH, Mir AW, Wani JG, Hussain SQ. Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study. Anesth Essays Res 2017; 11:998-1003.
[11] Rajan S, Talukdar R, Tosh P, Paul J, Vasu BK, Kumar L. Hemodynamic responses and safety of sedation following premedication with dexmedetomidine and fentanyl during fiberoptic-assisted intubation in patients with predicted difficult airway. Anesth Essays Res. 2018; 12:11-5.
[12] Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992; 77:1125-33.
[13] Bloor BC, Ward DS, Belleville JP. Effects of intravenous dexmedetomidine in humans. Hemodynamic changes. Anesthesiology. 1992; 77:1134-42.
[14] Niyogi S, Basak S, Acharjee A, Chakraborty I. Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation. Indian J Anaesth. 2017; 61:137-43.
[15] American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non‐Anesthesiologists. Practice guidelines for sedation and analgesia by non‐anesthesiologists. Anesthesiology. 2002; 96:1004‐17.
[16] Chawda PM, Pareek MK, Mehta KD. Effect of nalbuphine on haemodynamic response to orotracheal intubation. J Anaesthesiol Clin Pharmacol. 2010; 26:458‐60.
[17] Chaudhari MJ, Bhatia U, Patel N. Efficacy of nalbuphine in preventing hemodynamic response to laryngoscopy and intubation in comparison to clonidine. NHL J Med Sci. 2015; 4:58-65.
[18] Sharma K, Audichya PC, Goyal S, Soni K, Petkar J. Randomized comparison of tramadol, nalbuphine and fentanyl used as premedication in attenuation of hemodynamic response to laryngoscopy and postoperative pain in laparoscopic cholecystecyomy. Int J Med Sci Clin Invent 2016; 3:1968-76.
[19] El Mourad MB, Elghamry MR, Mansour RF, Afandy ME. Comparison of intravenous dexmedetomidine-propofol versus ketofol for sedation during awake fiberoptic intubation: A prospective, randomized study. Anesth Pain Med. 2019; 9:e86442.
[20] Chalam KS. A comparative study of intravenous dexmedetomidine-versus propofol-based sedation for awake fiberoptic intubation along with airway blocks in cervical discectomy patients. Karnataka Anaesth J. 2015;1:21-7.
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Issue | Vol 9 No Supp. 1 (2023): Supplement 1 | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v9i5.13955 | |
Keywords | ||
Airway management Awake fiberoptic intubation Dexmedetomidine Difficult airway Nalbuphine |
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