E 1 Post-intubation score two Ramsay sedation scale (RSS) SpO2 94 SpO2 95SpO2 = Oxygen saturationGroup A 28 two 24 6 3.371 4Group B 3 27 three 27 two.07.254 25P value0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.Table three: Baseline and post-intubation MAP baseline and , post-intubation HR Hemodynamic parameters Baseline MAP (imply D) (mm of Hg) Post-intubation MAP (imply D) (mm of Hg) P value Baseline HR (mean D) (beats/min) Post-intubation HR (imply D) (beats/min) P value Group A (dexmedetomidine group) 94.43.668 Group B (fentanyl group) 94.23.P value0.95.03.114.171.0.347 77.466.0.0001 77.7670.0.DiscussionThe ASA challenging airway algorithm emphasizes on awake intubation and tracheostomy as major or alternate selections in tricky airway conditions.[10] Now-a-days, AFOI could be the preferred technique for securing a challenging airway. Different drugs have been attempted to attain conscious sedation αLβ2 Antagonist Storage & Stability during AFOI. Fentanyl is often a phenylpiperidine derivative of synthetic opioid, which supplies mild sedation, analgesia along with hemodynamic stability, that are useful for AFOI but there’s a danger of respiratory depression, nausea and vomiting and chest wall rigidity.[11-13] Dexmedetomidine is actually a hugely selective, centrally acting -2 agonist. It acts on presynaptic -2 receptors to provide unfavorable feedback causing significantly less neurotransmitter (norepinephrine, epinephrine) accessible at post-synaptic -1 receptors. It produces hypnosis, amnesia, analgesia, anxiolysis, PI3K Inhibitor Gene ID sympatholysis and antisialogogue effects all of75.1136.0.0.SD = Typical deviation, MAP = Mean arterial stress, HR = Heart ratewhich are desirable during AFOI.[14] Dexmedetomidine induces sedation involving activation of endogenous sleep advertising pathway by way of the post-synaptic -2 receptors inside the locus ceruleus, which modulates wakefulness. The major positive aspects of dexmedetomidine infusion throughout AFOI are a one of a kind form of sedation where patients remain sleepy, but are quickly aroused, cooperative with minimum respiratory impairment. The feasibility of dexmedetomidine has been not too long ago studied either as a sole sedative agent or as an adjuvant during AFOI.[15,16] We compared dexmedetomidine 1 mcg/kg (Group A) with fentanyl 2 mcg/kg (Group B) and discovered additional favorableJournal of Anaesthesiology Clinical Pharmacology | April-June 2015 | Vol 31 | IssueMondal, et al.: Dexmedetomidine vs. fentanyl for awake fiberoptic intubationintubation situations and much better tolerance to intubation in dexmedetomidine group than fentanyl group. The majority of the sufferers (28 out of 30) of Group A, but only three individuals of Group B had cough score two. Poor post-intubation Score (2) was located in 27 sufferers of Group B and six sufferers of Group A (P 0.0001). Chu et al.[10] observed improved tolerance to intubation without the need of respiratory depression and upper airway obstruction in dexmedetomidine group (1 mcg/kg) compared with fentanyl group (1 mcg/kg). In our study, dexmedetomidine made superior intubating situations than fentanyl utilized in dose of two mcg/kg. Dexmedetomidine has also been proved as an efficient agent for AFOI in certain complicated airway scenarios.[17-19] Bergese et al.[20] noted that dexmedetomidine at 1 mcg/kg bolus was protected and valuable for patients undergoing AFOI even devoid of airway nerve block or topical anesthesia. Bergese et al.[20] discovered that dexmedetomidine in combination with low dose midazolam is more productive than midazolam alone for sedation in AFOI. Nevertheless, dexmedetomidine dose in excess of 1 mcg/kg/h with midazolam.
