Comparison of Dexmedetomidine vs Midazolam for Sedation during Awake Fiberoptic Intubation in Oral Cancer Surgeries- A Randomised Clinical Study

Abstract

Introduction: Fiberoptic nasotracheal intubation is a prime method for managing difficult airway in patients. Besides local blocks, some sedation is required during the procedure to make it more tolerable to the patients. Dexmedetomidine (DEX) and Midazolam (MDZ) can be used for this purpose. Aim: To compare dexmedetomidine versus midazolam for sedation and intubating condition during Awake Fiberoptic Intubation (AFOI) in patients undergoing oral cancer surgeries. Materials and Methods: This was a prospective randomised double blind study on total of 60 patients randomly allocated into group 1(MDZ) and group 2(DEX). Group 1 received intravenous (i.v.) Midazolam 0.05 mg/kg bolus in 10 mL normal saline over 10 minutes followed by 0.1 mg/kg/hr infusion titrated upto 0.2 mg/ kg/hr to achieve a Ramsay Sedation Score (RSS) ≥2. Group 2 (DEX) received i.v. Dexmedetomidine 1 μg/kg bolus in 10 mL normal saline over 10 minutes followed by infusion at the rate of 0.2 μg/kg/ hr titrated upto 0.7 μg/kg/hr to achieve a RSS ≥2. Comfort Scale values, haemodynamic parameters, patient’s tolerance score and patient’s satisfaction score (24 hours after the surgery) were assessed. Significance was calculated using Student t-test. The number of patients with adverse effects was compared using Chi- square test. Results: In the total sample of 60 patients (30 subjects in MDZ group and 30 subjects in DEX group). The demographic data, blood pressure and Oxygen(O2) saturation were comparable. Significant change in Heart Rate (HR) was observed in group MDZ while HR was stable in DEX group (p<0.001). Group DEX patients were more comfortable and had greater endurance with tolerance score <2.5 compared to MDZ group >2.5 (p<0.001) and had an acceptable level of RSS. After 24 hours, DEX group patients judged their sedation more positively than MDZ group with a score of 6.16 vs. 3.6 (p<0.001). Conclusion: Both Midazolam and Dexmedetomidine are effective for AFOI. But Dexmedetomidine provided better patient comfort and satisfaction along with stable haemodynamics.