COMPARISON OF DEXMEDETOMIDINE, FENTANYL, AND KETAMINE NEBULIZATION AS AN ADJUVANT TO LIGNOCAINE FOR AWAKE FIBREOPTIC INTUBATION
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Abstract
Introduction:
Awake fibreoptic intubation (AFOI) is often indicated in patients with difficult airways. Achieving optimal patient comfort and maintaining adequate airway reflex suppression are paramount. Nebulized lignocaine is routinely used to anesthetize the airway; however, its efficacy may be enhanced by the addition of adjuvants. This study compares dexmedetomidine, fentanyl, and ketamine nebulization as adjuvants to lignocaine in facilitating AFOI.
Material and Methods:
In this prospective, randomized study was conducted in the Department of Anaesthesia, Shadan Institute of Medical Sciences, Teaching Hospital & Research Center over a period of 6 months. Total 90 patients scheduled for AFOI were allocated into three groups to receive nebulization with lignocaine plus either dexmedetomidine, fentanyl, or ketamine. Standard monitoring was employed to assess intubating conditions, hemodynamic responses, sedation scores, patient comfort, and adverse events. Data were analyzed using appropriate statistical tests.
Results: Group K (ketamine) demonstrated superior intubating conditions compared to Groups D and F, with significantly better scores for ease of intubation, patient comfort, and reduced coughing and movement (p < 0.05). Group K also had the shortest time to intubation (7.9 ± 1.3 minutes) and the highest Ramsay Sedation Score (4.5 ± 0.4). Hemodynamic stability was comparable across groups, with minor variations in post-intubation heart rate and MAP. Group K had a higher incidence of emergence phenomena (10%), while desaturation, hypotension, and bradycardia were rare and comparable across groups.Group K reported the highest satisfaction scores (9.2 ± 0.9), followed by Group D and Group F.
Conclusion:
Nebulization with dexmedetomidine, fentanyl, or ketamine as an adjuvant to lignocaine can enhance the success and tolerability of awake fibreoptic intubation. Dexmedetomidine appears to offer the most balanced profile in terms of sedation, hemodynamic stability, and patient comfort.