Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial
Background and objectives: Awake fiberoptic intubation (AFOI) is usually performed in patients with an anticipated difficult airway. Various sedation regimens are used during AFOI, however, most of them cause respiratory depression. The present study aims to compare the effectiveness of fentanyl wit...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421000889 |
| _version_ | 1797997648792256512 |
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| author | Anil Kumar Verma Shipra Verma Amiya Kumar Barik Vinay Kanaujia Sangeeta Arya |
| author_facet | Anil Kumar Verma Shipra Verma Amiya Kumar Barik Vinay Kanaujia Sangeeta Arya |
| author_sort | Anil Kumar Verma |
| collection | DOAJ |
| description | Background and objectives: Awake fiberoptic intubation (AFOI) is usually performed in patients with an anticipated difficult airway. Various sedation regimens are used during AFOI, however, most of them cause respiratory depression. The present study aims to compare the effectiveness of fentanyl with ketamine versus dexmedetomidine in search of a better sedation regimen which would achieve desirable intubating conditions and hemodynamic stability without causing respiratory depression. Methods: This is a single centered randomized, double-blind clinical trial. Patients of both sexes between age 18–55 years and ASA (American Society of Anesthesiologists) physical status I–II with an anticipated difficult airway were randomly divided into two groups of thirty each. Group FK patients received intravenous fentanyl and ketamine, and group DX patients received dexmedetomidine, until Ramsay sedation scale ≥ 2. Heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), respiratory rate (RR), endoscopy time, intubation time, first end-tidal carbon dioxide (ETCO2) after intubation, endoscopist satisfaction score, and patient discomfort score were recorded during the study period. The level of recall was assessed on the next postoperative day. Results: Endoscopist satisfaction score was better in group DX patients (p < 0.05). There was a smaller variation in HR and MBP from baseline with dexmedetomidine compared to fentanyl with ketamine. First ETCO2 after intubation was higher in group FK patients (p < 0.05). No significant difference was found in patient discomfort score, intubation time, RR, SpO2 and level of recall of the event. Conclusions: The use of dexmedetomidine in AFOI provides better intubating conditions and hemodynamic stability compared to fentanyl with ketamine. |
| first_indexed | 2024-04-11T10:36:14Z |
| format | Article |
| id | doaj.art-cce6c49be2594be08ed8b1a383150c68 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-11T10:36:14Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-cce6c49be2594be08ed8b1a383150c682022-12-22T04:29:18ZengElsevierBrazilian Journal of Anesthesiology0104-00142021-05-01713259264Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trialAnil Kumar Verma0Shipra Verma1Amiya Kumar Barik2Vinay Kanaujia3Sangeeta Arya4G.S.V.M. Medical College, Department of Anaesthesiology and Critical Care, Kanpur, IndiaS.M.M.H. Medical College, Department of Anaesthesiology and Critical Care, Saharanpur, India; Corresponding author.AIIMS, Department of Anaesthesiology and Critical Care, Bhopal, IndiaS.M.M.H. Medical College, Department of Physical Medicine & Rehabilitation, Saharanpur, IndiaGovernment Medical College, Department of Obstetrics and Gynaecology, Banda, IndiaBackground and objectives: Awake fiberoptic intubation (AFOI) is usually performed in patients with an anticipated difficult airway. Various sedation regimens are used during AFOI, however, most of them cause respiratory depression. The present study aims to compare the effectiveness of fentanyl with ketamine versus dexmedetomidine in search of a better sedation regimen which would achieve desirable intubating conditions and hemodynamic stability without causing respiratory depression. Methods: This is a single centered randomized, double-blind clinical trial. Patients of both sexes between age 18–55 years and ASA (American Society of Anesthesiologists) physical status I–II with an anticipated difficult airway were randomly divided into two groups of thirty each. Group FK patients received intravenous fentanyl and ketamine, and group DX patients received dexmedetomidine, until Ramsay sedation scale ≥ 2. Heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), respiratory rate (RR), endoscopy time, intubation time, first end-tidal carbon dioxide (ETCO2) after intubation, endoscopist satisfaction score, and patient discomfort score were recorded during the study period. The level of recall was assessed on the next postoperative day. Results: Endoscopist satisfaction score was better in group DX patients (p < 0.05). There was a smaller variation in HR and MBP from baseline with dexmedetomidine compared to fentanyl with ketamine. First ETCO2 after intubation was higher in group FK patients (p < 0.05). No significant difference was found in patient discomfort score, intubation time, RR, SpO2 and level of recall of the event. Conclusions: The use of dexmedetomidine in AFOI provides better intubating conditions and hemodynamic stability compared to fentanyl with ketamine.http://www.sciencedirect.com/science/article/pii/S0104001421000889Airway managementFiberoptic intubationFentanylKetamineDexmedetomidine |
| spellingShingle | Anil Kumar Verma Shipra Verma Amiya Kumar Barik Vinay Kanaujia Sangeeta Arya Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial Brazilian Journal of Anesthesiology Airway management Fiberoptic intubation Fentanyl Ketamine Dexmedetomidine |
| title | Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial |
| title_full | Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial |
| title_fullStr | Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial |
| title_full_unstemmed | Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial |
| title_short | Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial |
| title_sort | intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway a randomized clinical trial |
| topic | Airway management Fiberoptic intubation Fentanyl Ketamine Dexmedetomidine |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421000889 |
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