A comparative study between dexmedetomidine versus fentanyl to facilitate awake fibreoptic nasal intubation under general Anaesthesia

Aim: To compares the efficacy, safety, and impact of Dexmedetomidine and Fentanyl on hemodynamic and respiratory parameters during AFOI. Materials and Methods: This prospective, randomized, endpoint-blinded study included 50 patients (ASA I/II, aged 20-50 years) undergoing elective surgery with anticipated difficult airways. Criteria included Mallampati Grade III/IV, restricted mouth opening, or thyromental distance <6.5 cm. Patients were randomly assigned into two groups: Group D received dexmedetomidine 1 mcg/kg and Group F received fentanyl 2 mcg/kg, both via slow infusion over 10 minutes. Sedation level was assessed using the Ramsay Sedation Score (RSS), intubation quality via cough and post-intubation scores, and hemodynamic parameters (HR, BP, SpO2) were monitored intra-and post-operatively. Side effects such as bradycardia, hypotension, nausea, and hypoxia were also recorded. Results: Dexmedetomidine provided superior intubation conditions with significantly lower cough scores (1.44±1.23 vs. 2.88±1.59, p<0.001), higher sedation (RSS 3.87±0.87 vs. 2.74±0.81, p<0.001), and better patient tolerance. Time to intubation and fiberoptic scope insertion was also shorter in Group D. Hemodynamic analysis revealed significantly lower HR and BP in Group D but at the cost of increased hypotension (24%) and bradycardia (32%). Group F, while more hemodynamically stable, had more hypoxia (24% vs. 4%) and nausea. Conclusion: Dexmedetomidine offers better sedation, intubation conditions, and patient comfort than fentanyl in awake fibreoptic nasal intubation. However, its use requires vigilance due to its cardiovascular effects. Fentanyl, while easier on hemodynamics, presents greater risks of respiratory depression. Hence, dexmedetomidine is preferable when deeper sedation and improved airway conditions are prioritized.