Efficacy of Intranasal Dexmedetomidine with Lidocaine Versus Intranasal Lidocaine Alone in Awake Fiberoptic Nasotracheal IntubationA Randomised Clinical Study

Abstract

Introduction: Awake Fiberoptic Intubation (AFOI) is considered as the gold standard technique in patients with predicted and unpredicted difficult airway. It is best performed with the patient awake to maintain spontaneous ventilation. Dexmedetomidine has been successful in several clinical settings including AFOI due to its diverse actions like sedation, analgesia, anxiolysis, cardiovascular stabilising effect and preservation of respiratory function. Aim: To assess the efficacy of using dexmedetomidine intranasally with lidocaine in AFOI in comparison to using lidocaine alone in terms of haemodynamic stability, sedation, ease of intubation, patient’s satisfaction with the procedure and reduction in intraoperative propofol requirement. Materials and Methods: This randomised clinical study was conducted on 100 patients of either gender aged between 18-60 years with ASA physical status I or II scheduled for elective surgeries under general anaesthesia at Government Medical College and Rajindra Hospital, Patiala, India from February 2021 to November 2021. The patients were randomly divided into two groups of 50 each namely Group D (intranasal dexmedetomidine 2 mcg/kg + lidocaine 10%) and Group L (intranasal lidocaine 10% alone). Maximum dose of 10% Lidocaine was <5 mg/kg body weight in both groups. The various parameters were recorded in both the groups during AFOI and the data was analysed using Statistical Package for Social Sciences (SPSS) software version 22.0 and Microsoft excel. Descriptive statistics was done for all data and were reported in terms of mean, standard deviation and percentages. Results: Among 100 patients, group D and group L comprises of 50 each. The mean heart rate during AFOI was 70.16±8.02 in Group D, and 95.62±11.04, in Group L. The Mean Arterial Pressure (MAP) during AFOI was 81.42±5.55 in group D and 101.78±6.22, in group L. There was statistically highly significant (p-value <0.001) decrease in mean heart rate and MAP (within normal clinical range) in group D as compared to group L. The mean Ramsay Sedation Scale (RSS) in group D was 3.66 ± 0.48 and in group L was 2.32±0.55 (p-value <0.001). There was a significant difference (p-value <0.001) in patient tolerance, time to intubation, propofol requirement, patient satisfaction and anaesthesiologist satisfaction between the two groups. There was no significant decrease in Saturation of Peripheral Oxygen (SpO2 ) or respiratory depression in both groups (p-value=0.221). Conclusion: Intranasal dexmedetomidine with lidocaine provides better haemodynamic stability and improves the quality of intubation, reduces propofol requirement, provides good patient and anaesthesiologist satisfaction and maintains oxygen saturation during AFOI.