Comparison between Fentanyl, Clonidine and Dexmedetomidine for Awake Fiberoptic Intubation
Abstract
Background: Currently Awake fibreoptic intubation - (AFOI) is the gold standard for the management of patients with an anticipated difficult airway. Various medications have been used to perform intubation during AFOI. The ideal drug for AFOI must provide comfort, cooperation, amnesia and hemodynamic stability along with maintenance of spontaneous respiration. The study aimed to compare fentanyl, clonidine and dexmedetomidine in providing favourable intubating conditions along with hemodynamic stability during AFOI.
Methods: This prospective and randomized trial was carried out in 90 patients who were scheduled for elective surgery and required awake fibreoptic intubation. The patients were randomly divided into three different groups; Group A: Received Injection Dexmedetomidine-1ug/kg over 10 minutes; Group B: Received Injection Clonidine -2ug/kg over 10 minutes; and Group C: Received Injection Fentanyl- 2ug/kg over 10 minutes. Cough score, post-intubation score, Ramsay sedation score (RSS) and the changes in hemodynamic, were used to evaluate the effectiveness of the intubation condition and the results were then compared among the groups.
Results: Demographic variables such as gender, age, weight and American Society of Anaesthesiologists-Physical Status ASA-PS (I/II) were comparable among the three groups and not statistically significant. The cough score and the post intubation score were lower in Group A. RSS was noted to be higher in Group A and there was a lower incidence of desaturation. Hemodynamic parameters were also favourable in Group A.
Conclusion: Dexmedetomidine was found to be more effective than clonidine and fentanyl in those undergoing awake fibreoptic intubation. There were fewer adverse effects such as coughing, discomfort, oxygen desaturation, and intolerance to intubation.
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