Dexmedetomidine - lidocaine nebulisation for awake nasotracheal intubation: An observational cross-sectional study

Optimal airway topicalisation is the key to successful and smooth awake intubation in anticipated difficult airway. Dexmedetomidine nebulisation has been used effectively as premedication and could be a useful adjunct to lidocaine for awake fiberoptic intubation (AFOI). This study evaluated the efficacy of dexmedetomidine-lidocaine nebulisation for AFOI. To compare the efficacy of Dexmedetomidine with lignocaine versus Plain Lignocaine nebulization to achieve successful airway placement for awake fiberoptic intubation (AFOI). To assess the degree of patient comfort during the procedure on basis of cough score, gaging reflex score, intubating conditions, vocal cord position, patient behaviour and to assess the hemodynamic stability and the time taken for AFOI. 96 adult patients, ASA grades I-III with anticipated difficult intubation requiring AFOI for elective surgery were enrolled. Patients received nebulisation with dexmedetomidine 1mcg/kg + 4ml of 4% lidocaine (Group A, n=48) & 4ml of 4% plain lidocaine (Group B, n=48). Outcomes were assessed by an independent observer. Primary outcome of cough and gag reflex was assessed on basis of four-point intubation condition assessment score. Secondary outcomes assessed were patient comfort using five-point intubation comfort scale, three-point behaviour scale, hemodynamic stability, additional sedation, lidocaine aliquots, intubation attempts and complications. Fischer exact test was used for categorical variables and Mann -Whitney / independent student t-test for continuous variables.P values < 0.05 was considered statistically significant. : Both groups displayed similar demographic profiles. While all patients were successfully intubated, Group A exhibited better intubating condition grades (p<0.001) and lower cough scores compared to Group B (p<0.001). Patient comfort (p<0.001) and hemodynamic stability (p<0.05) was better in Group A. Only 3 patients in Group A required additional sedation compared with 19 patients in Group B (p<0.001). This study demonstrated superior efficacy of dexmedetomidine- lidocaine nebulisation in providing optimal intubating conditions for AFOI.