OBJECTIVETo compare the effects of dexmedetomidine and midazolam with fentanyl with anticipated difficult intubation during awake blind nasal intubation on respiration and hemodynamics of patients.

METHODSForty patients (ASA class I to II) undergoing selective oral and maxillofacial surgeries with anticipated difficult intubation were enrolled in the study. The patients were randomly assigned into two equal groups. Experimental group received dexmedetomidine, control group received midazolam and fentanyl. The Ramsay sedation scores, mean artery pressure (MAP), heart rate (HR), respiratory rate (RR) and blood oxygen saturation of pulse (SpO2) were recorded at baseline (TI), beginning to intubate (T2), 10 min after beginning to intubate (T3), 20 min after beginning to intubate (T4), and after intubation (T5). The operative time for intubation, intubation times, success rate of intubation, the anesthetic effects and complications were recorded.

RESULTSThe success rate in the experimental group was significantly higher than that in the control group (P<0.05). Intubation times in the experimental group was less than that in the control group (P<0.05). The incidence of complications such as nausea, vomiting, cough and throat unwell in the control group was higher. Compared with the T1, RR decreased at T2 in the control group, but RR increased significantly at T4 and T5. RR and SpO2 had no significant change in the experimental group. Compared with T1, MAP and HR increased at T3, T4 and T5 in the control group (P<0.05). MAP and HR showed no significant variations in the experimental group (P>0.05). The Ramsay sedation scores in the control group were lower than those in the experimental group (P<0.05).

CONCLUSIONAppropriate application of dexmedetomidine can be safer and more effective than midazolam with fentanyl for awake blind intubation.