Comparison between Intravenous Dexmedetomidine and Spray as you Go with 4% Lignocaine Versus Intravenous Fentanyl and Transtracheal Injection of 4% Lignocaine for Awake Nasotracheal Intubation with Flexible Vedioscope – A Randomized Single-Blind Prospective Study

BACKGROUND: Awake fiber-optic bronchoscopy-guided intubation is the method of choice in difficult airway which requires effective airway anesthesia to ensure patient comfort and acceptance. AIMS: This study was conducted to assess the quality of airway anesthesia, patient comfort during intubation, and postoperative satisfaction of patients. SETTINGS: Patients posted for surgeries under general anesthesia with Mallampati Grade I and II in a medical college. Patients were followed in the operation theater and postoperative ward. STUDY DESIGN: This was a prospective randomized single-blind study. MATERIALS AND METHODS: Group D received intravenous (i.v.) dexmedetomidine 1 μg.kg(−1) i.v. over 10 min and 3 ml of 4% lignocaine spray as you go (SAYGo). Group F received i.v. fentanyl 2 μg.kg(−1) over 10 min and transtracheal injection 3 ml of 4% lignocaine. Parameters assessed were endoscopic time, intubating condition, vocal cord position, cough severity, comfort during intubation, postoperative patient satisfaction, and any adverse effects such as sore throat, hoarseness, unpleasant memories, and hemodynamic response during intubation. STATISTICAL ANALYSIS: Independent Student's t-test, Mann–Whitney, Chi-squared test, or Fisher's exact test were used. P ≤ 0.05 was considered statistically significant. RESULTS: Intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative patient satisfaction were statistically significant (P ≤ 0.05) in favor of Group D though endoscopic time was longer. CONCLUSION: IV dexmedetomidine with SAYGo is effective than IV fentanyl with transtracheal block for awake fiber-optic videoscopic intubation in terms of intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative satisfaction of patients with significant attenuation of postintubation hemodynamic response and better preservation of respiration though endoscopic time is more.