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A prospective randomized study to compare analgesic and sedative effect of midazolam and nalbuphine with midazolam and fentanyl in patients undergoing awake fiberoptic intubation

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Original Article

Author Details : Kaur Harpreet, Singh Harjeet*, Mohan Brij, Sood R Ojaswani, Jaspreet

Volume : 6, Issue : 2, Year : 2019

Article Page : 235-241

https://doi.org/10.18231/j.ijca.2019.044

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Abstract

Introduction: Awake fiberoptic intubation (AFOI) under sedation and local anaesthesia is gold standard in anticipated difficult airway scenarios. Various drugs are used to achieve conscious sedation with adequate analgesia such as propofol, fentanyl, nalbuphine and midazolam. In this study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing AFOI using spray as you go method.
Materials and Methods: 60 patients between the age of 18 and 60yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score.
Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F.
Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.

Keywords: Fiberoptic, Intubation, Spray as you go, Fentanyl, Nalbuphine.

How to cite : Harpreet K, Harjeet S, Brij M, Ojaswani S R, Jaspreet, A prospective randomized study to compare analgesic and sedative effect of midazolam and nalbuphine with midazolam and fentanyl in patients undergoing awake fiberoptic intubation. Indian J Clin Anaesth 2019;6(2):235-241

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