Dexmedetomidine versus midazolam for conscious sedation during blind nasotracheal intubation with bispectral index monitoring: a randomized and controlled clinical trial

Abstract

AbstractObjective Despite the rapid progress of tracheal intubation visualization techniques, blind nasotracheal intubation remains a significant approach for difficult airway management, requiring satisfactory conscious sedation. The purpose of this study was to evaluate and compare the efficacy and safety of dexmedetomidine (DEX) and midazolam (MID) for conscious sedation during blind nasotracheal intubation under bispectral index (BIS) monitoring. Methods This study included 60 patients undergoing elective oral and maxillofacial surgery who were randomized into two groups: the DEX group (dexmedetomidine, 1.0 µg/kg, continuous infusion for 15 minutes) and the MID group (midazolam, 0.02 mg/kg). Under BIS monitoring, the primary outcome, time of intubation, was recorded. Additionally, changes in vital signs and stress hormone levels were measured before and after intubation. Intraoperative sufentanil consumption was determined, and such parameters as the end-tidal carbon dioxide partial pressure (PETCO2) after intubation as well as pain and satisfaction scores were assessed. Also, postoperatively, the incidence of adverse events associated with nasotracheal intubation was assessed in both groups. Results All patients successfully intubated. The DEX group had a shorter intubation time (P < 0.05) when compared to the MID group. In comparison to pre-induction values, BIS, heart rate (HR) and mean arterial pressure (MAP) were significantly decreased after induction of anesthesia in both groups (P < 0.05), with BIS (P < 0.001) and HR (P = 0.001) being significantly lower in the DEX group than the MID group. BIS, MAP and pulse oximeter oxygen saturation (SpO2) immediately after intubation were significantly lower in both groups than before the induction.HR was significantly lower in DEX group than that in the MID group (P < 0.05). The levels of epinephrine (E), and beta-endorphin (β-EP) were significantly reduced at three and fifteen minutes after intubation in the MID group compared to pre-induction values (P < 0.05). Similarly, compared to pre-induction, at three and fifteen minutes after intubation, cortisol (Cor), norepinephrine (NE), E, and β-EP were significantly lower in both groups (P < 0.05). Moreover, the DEX group had lower PETCO2post-intubation, lower sufentanil consumption, lower postoperative pain scores, and higher patient satisfaction scores (P < 0.05). Conclusion Although, using BIS monitoring, both DEX and MID have shown safe and effective conscious sedation for blind nasotracheal intubation, the efficacy of DEX is greater than that of MID. Trial registration: This study was registered on the China Clinical Trial Registry website (https://www.chictr.org.cn/index.html) on 26/05/2023 (Registration number: ChiCTR2300071838).