DEXMEDETOMIDINE COMBINED WITH PROPOFOL TARGET-CONTROLLED INFUSION FOR SEDATION DURING AWAKE NASOTRACHEAL INTUBATION:A STUDY OF ITS SAFETY AND FEASIBILITY

Objective To evaluate the safety and feasibility of combined dexmedetomidine with propofol target-controlled infusion(TCI)for sedetion during awake fibreoptic nasotracheal intubation(FNI). Methods Sixty patients scheduled for a selective surgery(who were suspected of difficult tracheal intubation)were enrolled in this study.Before anesthesia induction,nasal cavity was cleaned,superficial anesthesia was done in upper respiratory tract and thyrocricoid puncture carried out.Patients were then received a loading dose of dexmedetomidine(0.5μg/kg)infused within 10 min.The initial target plasma concentration of propofol was set at 0.5mg/L.This was adjusted by 0.1mg/L according to the level of OAA/S during the procedure.Fibreoptic intubation was commenced at level three of OAA/S.The intubation time,the concentration of propofol and BIS were recorded.The mean arterial pressure(MAP),heart rate(HR),and respiration rate(RR)of the patients before induction(T1),immediately at intubation(T2),and at 2min after intubation(T3)were recorded.Intubation scores,patient tolerance,degree of confort at intubation were assessed. Results The intubation procedures were smoothly completed within four minutes in all the patients,with an average propofol dosage of(0.83±1.8)mg/L.and average BIS of 79.6±3.0.The differences between MAP and HR in different time points(T1,T2 and T3)were significant(F=272.12,56.15;q=2.98-39.34;P0.05),while that of RR was not significant(F=2.58,P0.05).In terms of intubation scoring,cough reflex,glottis movement and body motion were 100%,93%and 93%,respectively,and the satisfaction rate of degree of confort and tolerance was 93%and 98%. Conclusion Combined dexmedetomidine with propofol target-controlled infusion applied to pernasal awake sedating tracheal intubation is the safer and more effective anesthetic method.