Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study.

BACKGROUND AND AIMS: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI. MATERIAL AND METHODS: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups. RESULTS: Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B. CONCLUSION: Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI.

Successful resuscitation in a case of sudden cardiac arrest in an epileptic patient posted for spinal surgery.

A 17-year-old girl was posted for spinal surgery for traumatic spinal injury. The patient was a well-controlled epileptic with history of seizure since 8 years of her age. She was induced with thiopentone sodium and muscle relaxant atracurium was administered. Minutes after that, she had an episode of ventricular tachycardia, this converted to ventricular fibrillation despite of institution of cardiopulmonary resuscitation (CPR). CPR was continued for a prolonged period of 45 minutes and after 45 minutes, QRS complexes appeared and later sinus rhythm restored. Next 24 hours, she was kept on mechanical ventilation. Within 24 hours, Glasgow Coma Scale (GCS) improved and patient was conscious and extubated. We suggest that the neuromuscular blocking drug contributed to an anaphylactic reaction which might be the cause of cardiac arrest and highlight the importance of prolonged resuscitation and successful outcome in this scenario.