Nebulised Versus Intravenous Dexmedetomidine for Awake Fibreoptic Bronchoscope-Guided Intubation in Head and Neck Surgery: A Prospective, Double-Blind, Randomised Clinical Trial

Introduction: Awake fibreoptic intubation (AFOI) is gold standard for anticipated difficult airway management and allows for airway instrumentation while maintaining patient's respiratory drive through right sedative regimen.Nebulisation with dexmedetomidine offers a needle-free, patient-friendly approach and reduced systemic side effects.The aim of study was to compare sedative effect of IV dexmedetomidine with nebulised dexmedetomidine by obtaining 5-point intubation comfort score for AFOI in patients undergoing head and neck surgery.The secondary objective was to record haemodynamic variables, intubation time, coughing response, Ramsay Sedation Score (RSS), incidence of postoperative sore throat, and.future willingness.Methods: This prospective, double-blind, randomised trial was conducted in 128 patients undergoing head and neck surgery under general anaesthesia.Patients were randomly allocated into two groups (n=64 each) and nebulised preoperatively: Group I received IV dexmedetomidine 1 μg/kg diluted in 50 mL of normal saline (NS), infused using a syringe pump, along with nebulised 4% lignocaine (2.5 mL) diluted with NS to a total volume of 5 mL.Group N received 50 mL of IV NS infused intravenously through a syringe pump and nebulised dexmedetomidine 1 μg/kg combined with 4% lignocaine (2.5 mL), diluted with NS to a total volume of 5 mL.Dexmedetomidine was administered as a fixed single dose in both groups, without subsequent doses.Intraoperative haemodynamic parameters were monitored.Intubation response was assessed by coughing and 5-point intubation comfort score.RSS was also assessed.Statistical analysis was done using chi-square test and student t-test, p-value <0.05 was considered significant.Results: Both groups were demographically comparable in terms of age, gender, and weight.Group N showed better 5-point intubation comfort score (Group N: No reaction -22, slight grimacing -32, heavy grimacing -6, while in Group I, it was exhibited by 6, 38, and 12 patients, respectively) and the difference was statistically significant (p = 0.008), and lesser coughing (Group N: no coughing -37, slight-23, moderate to severe -4, while in Group I, it was exhibited by 8, 33, and 23 patients, respectively) and RSS demonstrated deeper sedation in Group I as compared to Group N (lower sedation scores were predominantly seen in Group N (26.6% and 67.2%), whereas higher scores were more frequent in Group I (54.7% and 26.6%) .Postoperative sore throat was absent in 58 (90.6%) patients in Group N compared to only 16 (25.0%) in Group I. Sore throat was reported in 6 patients in Group N and 48 patients in Group I and the difference was highly significant (p < .001).Conclusion: Results of this study support nebulised dexmedetomidine due to its ease of administration and stable haemodynamic effects as a noninvasive alternative to IV administration for sedation during awake fibreoptic nasotracheal intubation (AFONI).