Effect Of Remifentanil And Dexmedetomidine On Sedation And Analgesia During Awake Tracheal Intubation

Objective To explore the sedative and analgesic effects of remifentanil and dexmedetomidine on patients with difficult airway during awake tracheal intubation and its safety.Methods A total of 90 patients who were evaluated as having difficult airway before surgery and underwent elective surgery under general anesthesia were selected and divided into 3groups（n=30）using a random number table:Remifentanil+dexmedetomidine group（group RD）,remifentanil group（group R）,and dexmedetomidine group（group D）.group RD was given intravenous pump remifentanil 0.1μg/kg/min+dexmedetomidine 0.5μg/kg;group R was intravenously injected remifentanil 0.15μg/kg/min;Group D was intravenously injected with dexmedetomidine 1μg/kg,and all three groups were injected with constant speed for10min.At 3min and 6min of drug pump injection,the epidural catheter inserted into the injection hole of the video intubationscope was used as the drug delivery path,and 3m L 2%lidocaine was administered in the throat,near the glottis and inside the trachea respectively for airway surface anesthesia.After the infusion of sedative and analgesic drugs,the awake tracheal intubation was guided by the video intubationscope.Mean arterial pressure（MAP）and Heart rate（HR）of patients were recorded after 5min of quiet time（T₀）,immediately before implantation of the video intubationscope（T₁）,immediately upon completion of intubation（T₂）,and 2min after completion of intubation（T₃）.The concentrations of Epinephrine（E）and Norepinephrine（NE）were recorded at T₀and T₃.The cough score,body motor response score and respiratory depression were recorded during intubation.The success rate and total time of intubation were recorded.Ramsay sedation score before intubation;The satisfaction of patients with tracheal intubation during 24h follow-up.Results There were no significant differences in gender,age,BMI and ASA grading among the three groups（P>0.05）.Compared with T₀,MAP of group D increased at T₁,T₂and T_3,with statistical significance（P<0.05）,HR decreased at T₁,and HR increased at T₂,with statistical significance（P<0.05）.Compared with groups R and RD,MAP in group D was significantly higher at T₁,T₂and T₃,the difference was statistically significant（P<0.05）,HR was slower at T₁,the difference was statistically significant（P<0.05）,and HR was faster at T₂and T₃,the difference was statistically significant（P<0.05）.Compared with T₀,the concentrations of E and NE in 3 groups were increased at T₃,the difference was statistically significant（P<0.05）;compared with group R and group RD,the concentrations of E and NE in group D were higher at T₃,the difference was statistically significant（P<0.05）;Group D had the highest cough score and body motor response score during intubation,and the differences were statistically significant（P<0.05）.The incidence of respiratory depression in group R was the highest,and the difference was statistically significant（P<0.05）.There was no significant difference in the score of sedation before intubation and the success rate of one intubation among the three groups（P>0.05）.Compared with the other two groups,the group RD had the shortest intubation time and the highest patient satisfaction,the difference was statistically significant（P<0.05）.Conclusion Remifentanil combined with dexmedetomidine for awake tracheal intubation can better inhibit intubation reaction,and patients have less circulation fluctuation,less adverse reactions,and high satisfaction.