Intravenous Dexmedetomidine in Attenuating Intubation Response in Awake Fibreoptic Nasal Intubation

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Intravenous Dexmedetomidine in Attenuating Intubation Response in Awake Fibreoptic Nasal Intubation

Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 3

Abstract

Introduction: Fibreoptic intubation is a is an effective, safe and reliable technique for difficult airway management. Optimal intubating conditions and patient comfort are paramount while preparing the patient for fibreoptic intubation. Challenge associated with this procedure is to provide adequate sedation while maintaining a patent airway and ensuring ventilation. This procedure is accompanied with several pressor responses like tachycardia, hypertension and even arrhythmias. An ideal sedation regimen would provide patient comfort, blunting of airway reflexes, patient cooperation, haemodynamic stability, amnesia and the maintenance of a patent airway with spontaneous ventilation. Dexmedetomidine is a α-2 adreno receptor agonist is ideal for the management of patients with difficult airways. Dexmedetomidine infusion provides conscious sedation in which patient is co-operative and communicative. So we want to study efficacy of intravenous Dexmeditomidinein a attenuation of pressor response after Fibreoptic intubation. Material And Method: We included 60 patients in the age group of 20-55 years of either sex belonging to ASA grade I and II scheduled for elective surgical procedures under general anesthesia with anticipated difficult intubation in this study. Local anesthesia of upper airway was given by Lignocaine with adrenaline 2% topical solution applied to the more patent nostril, oral viscous Lignocaine gargles and intratracheal instillation of 2 ml of 4 % Lignocaine done by cricothyroid puncture. Patient received a loading dose of Dexmedetomidine 1 micrograms/ kg infused over 10 minutes. Pulse rate, blood pressure respiratory rate, oxygen saturation and sedation score were recorded prior to infusion , 10 minutes after infusion. Sedation score was assessed with Ramsay Sedation Scale. Above parameters were again recorded once the tube enters glottis, 1 minute, 3 minutes and 5 minutes after securing the endotracheal tube. Any event of breath-holding or laryngospasm were also noted. All parameters were compared to the baseline values. Observations: The decrease in mean pulse rate was observed throughout the procedure with maximum decrease 3 minutes after securing the endotracheal tube. There was decline in mean systolic blood pressure from basal value at all stages with maximum fall 5 minutes after securing the endotracheal tube. There was decline in mean diastolic blood pressure from basal value at all stages of the procedure with maximum fall 5 minutes after securing the endotracheal tube. SpO2 was maintained close to basal value at all stages of intubation with minimum value 97 and maximum 100. The mean respiratory rate at various stages of intubation was close to basal value with minimum value 12 and maximum value 14. Following Dexmedetomidine infusion all patients showed sedation score of 4 at further steps of the procedure as assessed by Ramsay Sedation Scale. Conclusion: We conclude that good local anesthesia of upper airway with 1 micrograms/kg infusion of Dexmedetomidine given over 10 minutes provides good intubating conditions, sedation, patients cooperation with attenuation of intubation response.

Authors and Affiliations

Dr. Jyoti V. Kulkarni

EP ID EP211049
DOI -
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