Comparison of propofol versus dexmedetomidine sedation for awake C-MAC® D-Blade video laryngoscopic nasotracheal intubation in patients with difficult airway: A randomised clinical study

Background and Aims: Awake intubation is the preferred method for securing difficult airways. We compared intravenous (IV) propofol and dexmedetomidine for C-MAC (R) D-blade-guided anticipated difficult nasotracheal intubation under conscious sedation. Methods: This randomised study included 60 patients with difficult airway (El-Ganzouri Score 4-9). After adequate airway preparation with IV midazolam 0.03 mg/kg and IV fentanyl 1 mu g/kg, in Group P, propofol was infused at 250 mu g/kg/min and in Group D, dexmedetomidine was infused at 1 mu g/kg over 10 min, then at 0.5 mu g/kg/h till a bispectral index (BIS) value 65-70 was achieved. Patients underwent C-MAC (R) D-blade video laryngoscope-guided nasotracheal intubation. The intubation score was the primary outcome measure. Secondary outcome measures included haemodynamic parameters, intubation time, number of attempts, the incidence of failed awake intubation, glottic view, time to achieve desired BIS, complications, study drug consumption and patient-reported satisfaction with the awake intubation technique. Quantitative variables were compared between groups using unpaired t-test/Welsch test/Mann-Whitney Test. Qualitative variables were correlated using the Chi-square test/Fisher's exact test. A P value of <0.05 was considered statistically significant. Results: The intubation score was significantly higher in Group D versus Group P (P = 0.007). Patient reaction to intubation, haemodynamic parameters and percentage of glottis opening score were more favourable in Group P. Coughing and vocal cord movement were comparable between the groups (P > 0.05). The time to target BIS was four times longer, and the time to intubate was 6 seconds longer in Group D. Conclusion: Successful awake C-MAC (R) D-blade video laryngoscopic intubation can be performed under dexmedetomidine/propofol conscious sedation, with propofol giving a better intubation score.