Researchers are evaluating the efficacy of dexmedetomidine, a sedative, to facilitate awake fibreoptic nasotracheal intubation (AFONI) in patients undergoing cancer surgeries where difficult airways are anticipated. A recent randomized, double-blind study compared three different doses of the drug – 0.5 µg/kg, 1 µg/kg, and 1.5 µg/kg – administered intravenously.
The study, published in PubMed, involved 90 patients scheduled for oromaxillofacial and oral malignancy surgeries. Researchers assessed airway obstruction scores, intubation scores measuring vocal movement, coughing, and limb movements, and a fibreoptic intubation comfort score. Sedation levels were measured using the Ramsay sedation score (RSS). The findings indicated that all three doses of dexmedetomidine, when used in conjunction with topical spray and an airway block, resulted in comparable airway obstruction scores, suggesting they all provided favorable conditions for AFONI.
Notably, the airway obstruction score did not differ significantly between the three groups (P = 0.78). Similarly, there were no significant differences in vocal movement (P = 0.15), coughing (P = 0.31), limb movement (P = 0.51), or the fibreoptic intubation comfort score (P = 0.49). However, the mean RSS was significantly higher in the 1.5 µg/kg group compared to the 0.5 µg/kg and 1 µg/kg groups (P = 0.001), indicating a greater level of sedation.
Previous research, detailed in the Journal of Anaesthesiol Clinical Pharmacology (2017), also investigated the apply of local dexmedetomidine during fibreoptic nasotracheal intubation, focusing on its effects on sedation rate and hemodynamic changes. Another study, as reported in Open Anesthesia Journal (2019), compared dexmedetomidine to sufentanil for conscious sedation during AFONI. A separate study, published in ScienceDirect in 2024, examined both nebulized and intravenous administration of dexmedetomidine at a dose of 1 μg.kg-1 to facilitate AFONI.
The current study’s findings suggest that, within the tested dosage range, clinicians have flexibility in selecting a dexmedetomidine dose for AFONI, balancing the need for adequate sedation with the desire to minimize potential side effects. The researchers concluded that all three doses tested provided favorable conditions for AFONI when combined with topical spray and airway block.
