Clinical Comparative Study Between Dexmedetomidine, Magnesium sulphate and Ketofol versus Midazolam for Sedation During Awake Fiberoptic Nasotracheal Intubation in Predicted Difficult Air ways Patients
Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 72, Issue 7
Abstract
<strong>Background and objectives: </strong>Awake fiber optic intubation (AFOI) is recommended technique in securing the airway in predicted difficult airway patients with sedation. However, it is not easy to achieve a comfortable sedation so conscious sedation is the key for a successful AFOI. The goal of the study to compare different conscious sedation strategies aimed to improve comfort and safety in patients prepared for elective surgeries. Subjects and Methods: Case control, randomized controlled study in predicted difficult airway patients scheduled for elective surgery under GA carried out at AL-Azhar University Hospitals after approval by the local ethical committee. 120 patients of age group 18-60 years old with ASA I and II prepared for nasal (AFOI) under conscious sedation after giving their informed written consent to participate in our study. The patients were randomly assigned into 4 groups: Group dexmedetomidine (DEX), group ketofol, group magnesium sulfate and group midazolam. HR, MAP, Oxygen saturation and end tidal CO2 were monitored. Sedation score, patient tolerance, patient satisfaction and intubation score (vocal cord movement and coughing) were assessed.<br /> <strong>Results: </strong>All patients were successfully intubated by fiber optic and none of them developed bradycardia or reduced MAP more than 20% from the base line during intubation. Group DEX mild decrease in MAP and HR (<10% fall when compared with the baseline value) after loading of drug and during intubation in contrast to midazolam, ketofol and magnesium sulphate, which increase during intubation. There was no statistically significant difference in the intubation scores, grimace score, time of intubation, number of attempts and saturation in between the groups with one episode of desaturation in group ketofol and two in group midazolam (P > 0.05). Group ketofol and midazolam patients were sedated deeper after the start of the study drugs than group DEX and none of the patients were sedated to a score of < 2 (modified OAA/S score) in either of the groups. Group magnesium showed lighter sedation level significantly different with other groups.<br /> <strong>Conclusion: </strong>Study showed DEX provides optimum sedation without compromising airway or hemodynamic stability with favorable intubation time and less intubation attempts during AFOI in comparison to magnesium sulphate, ketofol and midazolam patients with better patient tolerance and satisfaction.
Authors and Affiliations
Eman Helal
Keywords
Related Articles
- EP ID EP584250
- DOI 10.12816/ejhm.2018.10147
- Views 109
- Downloads 0
Awareness Level of Parents about Antibiotics Those Are Given to Children in Riyadh Region 2017
Background: Defect of use of antibiotics is bothering pediatricians. This defect is participating in the prevalence of one of global health problem called antibiotic Resistance. Many articles are supporting the idea that...
Role of Chest Ultrasound in Detecting Successful Pleurodesis in Patients with Malignant Pleural Effusion
<strong>Background: </strong>One of the easiest sign to identify during chest sonography is the movement of the visceral pleura compared to immobility of the parietal pleura. This sign of ‘pleural sliding’, firstly descr...
Misuse of Antibiotics Therapy in General Population of Saudi Arabia
<strong>Background:</strong> The misuse of antibiotic treatment is an important cause of emerging bacterial resistance. Taking antibiotics without prescription through self-medication, friends or relative opinions, or ph...
Prevention of Infective Endocarditis Following Dental Practices
<strong>Introduction:</strong> Different guidelines and different regimens for prevention of infective endocarditis following operative procedures have been recommended. The purpose of this review was to explore the effe...
Intracytoplasmic Sperm Injection Outcome in Patient at Risk of Poor Responder Using Mild Ovarian Stimulation Protocol versus Short Gonadotropin Releasing Hormone Agonist Protocol
<span>Background: </span><span>Poor ovarian response to stimulation in IVF cycles is a challenging and frustrating condition for both clinician and patient, due to its poor prognosis in terms of pregnancies and live birt...