Background: Currently Awake fibreoptic intubation-(AFOI) is the gold standard for the management of patients with an anticipated difficult airway. Various medications have been used to perform intubation during AFOI. The ideal drug for AFOI must provide comfort, cooperation, amnesia and hemodynamic stability along with maintenance of spontaneous respiration. The study aimed to compare fentanyl, clonidine and dexmedetomidine in providing favourable intubating conditions along with hemodynamic stability during AFOI. Methods: This prospective and randomized trial was carried out in 90 patients who were scheduled for elective surgery and required Awake fibreoptic intubation. The patients were randomly divided into three different groups, Group A: Received Injection Dexmedetomidine-1ug/kg over 10 minutes, Group B: Received Injection Clonidine-2ug/kg over 10 minutes, and Group C: Received Injection Fentanyl-2ug/kg over 10 minutes. Cough score, post-intubation score, Ramsay sedation score (RSS) and the changes in hemodynamic, were used to evaluate the effectiveness of the intubation condition and the results were then compared among the groups. Results: Demographic variables such as gender, age, weight and American Society of Anaesthesiologists-Physical Status ASA-PS (I/II) were comparable among the three groups and not statistically significant. The cough score and the post intubation score were lower in Group A. RSS was noted to be higher in Group A and there was a lower incidence of desaturation. Hemodynamic parameters were also favourable in Group A. Conclusion: Dexmedetomidine was found to be more effective than clonidine and fentanyl in those undergoing Awake fibreoptic intubation.   There were fewer adverse effects such as coughing, discomfort, oxygen desaturation, and intolerance to intubation.

Background: Awake oral flexible fiberoptic intubation (AFOI) is used in patients with expected difficult airways. Different drugs have been used for sedation and yet we need to define ideal drug with proper sedation and safety, less changes in hemodynamic stability and less airway compromise. We aimed to compare the efficacy of dexmedetomidine with fentanyl and midazolam during AFOI.Methods: In this randomized clinical trial, 52 patients undergoing elective surgery and candidate for AFOI were randomly allocated to two groups. First group received 1mcg/kg of dexmedetomidine in 10 minutes and then infusion of 0.5 mcg/kg/h and second group received 2 mcg/kg fentanyl and then 1 mg midazolam. Hemodynamic variables, O2 saturation (SpO2) were evaluated before and after sedation and after intubation. Ramsey sedation scale (RSS) and patient’s tolerance were evaluated during bronchoscopy and intubation.Results: Lower heart rate after intubation (p=0.008) and higher SpO2 before sedation (p<0.001) and after intubation (p=0.02) were observed in dexmedetomidine group compared to fentanyl group. The need for propofol for further sedation was comparable between groups (11.5% vs. 7.7%, respectively; p=0.63). Both groups had comparable RSS and tolerance during intubation.Conclusion: Dexmedetomidine compared to fentanyl and midazolam had comparable sedation with better hemodynamic stability and O2 saturation during AFOI.

Introduction: In this retrospective study a review of 40 cases of airway management for newborns with tracheoesophageal fistula (TEF) / esophageal atresia repair is presented. Almost all cases had associated cardiac anomalies. Materials and Methods: Selected management was Awake intubation with flow of oxygen via Mapelson F. Sedated Awake intubation was performed using Atropine 0. 02 mg/kg and Fentanyl1 μ g/kg, and then occlusion of the fistula with ligation. Result: In patients with small TEF, there was no problem in intubation and ventilation. Anesthesia management and post operative NICU care was performed for 26 cases with no problem, but in 14 cases there was difficulty for anesthesia management and NICU care. Conclusion: We had no complication with performing the Awake intubation technique.

Background: Management of difficult airway due to laryngeal mass is a major challenge to the anesthesiologists, and Awake fiberoptic intubation (AFOI) would be the technique of choice. Objectives: The current study aimed at comparing the effects of administration of dexmedetomidine-propofol or ketofol for sedation during AFOI in terms of intubation conditions, hemodynamic stability, and patients and anesthesiologist's satisfaction. Methods: Eighty adult patients, 18-60 years old, ASA (the American Society of Anesthesiologists) physical status I-III, with difficult airway due to laryngeal mass and planned for AFOI were enrolled. Sedation was randomly given to the patients according to their assigned group by either dexmedetomidine-propofol (group D; n = 40) or ketofol (group K; n = 40). Outcome variables included time to reach Ramsay sedation scale (RSS) ≥ 3, intubation time, number of patients in need of rescue propofol, patient's discomfort score, tolerance to endoscopy and intubation, hemodynamic parameters, patients and anesthesiologist's satisfaction, and occurrence of side effects. Results: Time to reach RSS ≥ 3 and intubation time were significantly shorter, and fewer patients required rescue propofol in the K group as compared to the D group (P = 0. 000*, and 0. 035*, respectively). Higher discomfort score and better tolerance to endoscopy and intubation were noticed in group K than group D, but with no statistical significance (P = 0. 132, 0. 137, and 0. 211, respectively). Patients in group D had significantly lower mean arterial pressure (MAP) and heart rate (HR) after the loading dose till five minutes after intubation (P = 0. 000*). There was no significant difference in patients' satisfaction between the two groups (P = 0. 687), while anesthesiologist's satisfaction was higher in group K compared with that of group D (P = 0. 013*). Cough score as well as incidence of unfavorable respiratory outcomes were not significantly different between the two groups (P = 0. 611, 0. 348, respectively). Conclusions: Ketofol and dexmedetomidine-propofol combination were suitable and satisfactory for AFOI. However, ketofol was more advantageous in offering faster onset of sedation, shorter intubation time, stable hemodynamic profile, as well as higher anesthesiologist's satisfaction when compared to dexmedetomidine-propofol.

Awake intubation is the choice for airway management in anticipated difficult airway (DA), which means establishing airway without induction of deep sedation; however, in cases where sedation is precarious, decision in emergency situations, success in Awake intubation is dependent on proper regional airway block. A 21 year old man with bilateral temporo-mandibular ankyolosis and a 25 years old female with mandibular hypoplasia suspected of having Pierre Robin syndrome were candidate for elective facial plastic surgery. Case one was intubated by flexible fiberoptic bronchoscope and case two with retrograde intubation. In DA with mandibular problem, Awake intubation is indicated under regional airway block and topicalization.