Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 4 2018 09 11 538 541 EN Valiollah Hassani ENT & Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Farhadi ENT & Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran Masood Mohseni Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Reza Safaeian Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Nasim Nikoobakht Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Saloomeh Sehat Kashani Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Reza Farahmand Rad Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Shayesteh Pourkand Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran Elham Mohebbi Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran 2018 06 20 2018 07 18 Background: Awake oral flexible fiberoptic intubation (AFOI) is used in patients with expected difficult airways. Different drugs have been used for sedation and yet we need to define ideal drug with proper sedation and safety, less changes in hemodynamic stability and less airway compromise. We aimed to compare the efficacy of dexmedetomidine with fentanyl and midazolam during AFOI. Methods: In this randomized clinical trial, 52 patients undergoing elective surgery and candidate for AFOI were randomly allocated to two groups. First group received 1mcg/kg of dexmedetomidine in 10 minutes and then infusion of 0.5 mcg/kg/h and second group received 2 mcg/kg fentanyl and then 1 mg midazolam. Hemodynamic variables, O2 saturation (SpO2) were evaluated before and after sedation and after intubation. Ramsey sedation scale (RSS) and patient’s tolerance were evaluated during bronchoscopy and intubation. Results: Lower heart rate after intubation (p=0.008) and higher SpO2 before sedation (p<0.001) and after intubation (p=0.02) were observed in dexmedetomidine group compared to fentanyl group. The need for propofol for further sedation was comparable between groups (11.5% vs. 7.7%, respectively; p=0.63). Both groups had comparable RSS and tolerance during intubation. Conclusion: Dexmedetomidine compared to fentanyl and midazolam had comparable sedation with better hemodynamic stability and O2 saturation during AFOI. https://aacc.tums.ac.ir/index.php/aacc/article/view/195 https://aacc.tums.ac.ir/index.php/aacc/article/download/195/343