The optimal dosage of dexmedetomidine in awake tracheal intubation

Objective To explore the optimal dosage of dexmedetomidine(Dex) combined with sufentanil in awake tracheal intubation. Methods Sixty patients scheduled to receive general anesthesia were randomly divided into three groups :group A,group B and group C, twenty patients in each group. Patients were monitored routinely, sufentanil 5μg were given for the induction, then Dex was given over ten minutes by micro-injection pump (group A: 0.5μg/kg, group B: 0.75μg/kg, group C: 1.0μg/kg) . Airway anesthesia was performed six minutes after Dex infusion. Five minutes after Dex completion, tracheal intubation was performed. Fluctuations in the hemodynamic and respiratory indicators were monitored. Then ramsay sedation scale, other side-effects and the assessment of intubating conditions were observed. The overall satisfaction of intubation was recorded in patients in twenty-four hours. Results ①The ramsay sedation scale before intubation in group B(4.3±0.7)points was higher than that in group A(3.3±0.4)points, p0.05. The ramsay sedation scale before intubation in group C(4.6±0.7)points was higher than that in group B(4.3±0.7)points, p0.05. ②After intubation, the HR increased from (63.7±6.7) beats/min to (72.4±7.1) beats/min in group A(P 0.05), there was no significant change in group B[from (64.9±6.3) beats/min to (65.8±6.0) beats/min] and in group C[from (60.9±7.8) beats/min to (61.6±7.2) beats/min](P 0.05). ③The incidence of cardiovascular adverse reactions was 1/20 in group A and B, which was lower than that in group C (6/20, P 0.05). ④The overall satisfaction of intubation of patients in group B(1.7±0.6 points)and C (1.6±0.6 points) was higher than that in group A(2.2±0.7 points)(P 0.05). Conclusions ①Dex combined with sufentanil on the top of superficial anesthesia is effective for awake tracheal intubation. ② Dex 0.75μg/kg combined with sufentanil 5μg is the optimal dose for awake tracheal intubation which can inhibit the stress response for tracheal intubation.