Remifentanil versus dexmedetomidine in awake fiberoptic bronchoscopy guided laryngeal surgeries

Background: Awake fiberoptic bronchoscopy (AFB) is an essential technique for securing the airway in patients with complex anatomical challenges, such as laryngeal masses, where conventional intubation may be difficult. This study compares the efficacy of remifentanil and dexmedetomidine for sedation during AFB in patients undergoing laryngeal surgery. Methods: This retrospective cohort study analyzed the data of 76 patients who underwent AFB for tracheal intubation between January 2021 and April 2024. The patients were divided into two sedation groups: Remifentanil (n = 38) and Dexmedetomidine (n = 38). The primary outcomes included intubation time, the number of intubation attempts, patient comfort scores, and postoperative cough scores. Sedation was titrated to achieve a Ramsay sedation score of 3–4, and to ensure comparability, baseline characteristics such as demographic data, American Society of Anesthesiologists (ASA) classifications and Mallampati scores were compared. Results: The baseline characteristics were similar between the two groups. However, dexmedetomidine was associated with significantly shorter intubation times (52.39 ± 16.94 vs. 70.50 ± 20.42 seconds, p < 0.01), fewer intubation attempts (1.58 ± 0.56 vs. 2.08 ± 0.62, p < 0.01) and better patient comfort scores (1.82 ± 0.56 vs. 2.13 ± 0.62, p = 0.02). Additionally, postoperative cough scores were lower in the dexmedetomidine group (2.00 ± 0.61 vs. 2.32 ± 0.57, p = 0.02), indicating reduced airway irritation after the procedure. Conclusions: Dexmedetomidine was associated with superior sedation compared to remifentanil for AFB in patients undergoing laryngeal surgery due to improved patient comfort, shortened intubation time and reduced number of intubation attempts. The lower postoperative cough scores further suggest a potential benefit in minimizing airway irritation. Given its minimal respiratory depressive effects and enhanced procedural efficiency, dexmedetomidine could be the preferred sedative agent for AFB in this patient population.