RANDOMIZED TRIAL FOR COMPARISON OF BUPRENORPHINE AND FENTANYL FOR AWAKE FIBEROPTIC INTUBATION

Authors

  • GAURAV GOYAL Department of Anaesthesia, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India. https://orcid.org/0000-0002-8006-034X
  • kiran yadav Department of Anaesthesia, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India. https://orcid.org/0000-0003-1612-0413
  • Kalpana Verma Department of Anaesthesia, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.
  • NAMITA GUPTA Department of Anaesthesia, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.
  • Sudhir sachdev Department of Anaesthesia, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i5.50676

Keywords:

Awake intubation, Buprenorphine, Difficult airway, Fentanyl

Abstract

Objectives: Awake fiberoptic intubation (AFOI) is a step-forward technique for successful intubation of patients with difficult airways. The popularity of its usage is increasing day by day in handling difficult airways. Our study aims to compare the efficacy and efficiency of Buprenorphine and Fentanyl as sedative agents for AFOI. The primary and secondary outcome measure was to assess hemodynamic response and on intubating condition of the patient after AFOI.

Methods: This randomized, prospective study was conducted in tertiary Center hospital. Total of 100 patient were enrolled for study and divided into two groups, Group A patients received intravenous Buprenorphine injection (2.5 (microgram/kilogram [μg/kg] over 10 min) and Group B Fentanyl injection (2 μg/kg over10 min) was injected prior to AFOI. The degree of sedation was assessed using the Observer’s assessment of alertness/sedation score (OAA/S), and the score of coughing during awake bronchoscopy was used to assess intubation status. Tolerability of intubation was assessed using a 5-point intubation score and a 3-point post-intubation assessment score immediately after the placement of the endotracheal tube into the trachea.

Results: Group A had more favorable OAA score than Group B, whereas other intubation conditions cough score, limb movement, 5-point intubation score, 3-point post intubation score was more favourable in Group B than in Group A.

Conclusion: Intravenous Fentanyl is better than Buprenorphine agent in terms of intubation score for AFOI. Both groups are comparable in terms of hemodynamic changes and stability.

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References

Kumar S, Chaudhary AK, Singh PK, Verma R, Chandra G, Bhatia VK, et al. Transdermal buprenorphine patches for postoperative pain control in abdominal surgery. J Clin Diagn Res. 2016 Jun;10(6):UC05-8. doi: 10.7860/JCDR/2016/18152.7982, PMID 27504383

Sharma J, Purohit S, Bhatia S, Kalra P, Sharma M, Meena R. Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery. Indian J Anaesth. 2017 Oct;61(10):811-7. doi: 10.4103/ija.IJA_169_17, PMID 29242653

Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A. Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study. J Anaesthesiol Clin Pharmacol. 2015 Apr;31(2):212-6. doi: 10.4103/0970-9185.155151, PMID 25948903

Tsai CJ, Chu KS, Chen TI, Lu DV, Wang HM, Lu IC. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010 Mar;65(3):254-9. doi: 10.1111/j.1365- 2044.2009.06226.x, PMID 20105150

Chaudhary S, Chaudhary S, Kumar M, Salhotra R. Fentanyl versus nalbuphine for intubating conditions during awake fiberoptic bronchoscopy: A randomized double-blind comparative study. J Anaesthesiol Clin Pharmacol. 2021 Jul;37(3):378-82. doi: 10.4103/ joacp.JOACP_359_19, PMID 34759547

Menkhaus PG, Reves JG, Kissin I, Alvis JM, Govier AV, Samuelson PN, et al. Cardiovascular effects of esmolol in anesthetized humans. Anesth Analg. 1985 Mar 1;64(3):327-34. doi: 10.1213/00000539-198503000- 00005, PMID 2858169

Rajan S, Talukdar R, Tosh P, Paul J, Vasu BK, Kumar L. Hemodynamic responses and safety of sedation following premedication with dexmedetomidine and fentanyl during fiberoptic-assisted intubation in patients with predicted difficult airway. Anesth Essays Res. 2018 Jan;12(1):11-5. doi: 10.4103/aer.AER_176_17, PMID 29628546

Dhiman S, Bhalotra AR, Kumari R, Sharma KR, Verma UC. Magnesium sulfate and fentanyl for facilitating awake fiberoptic nasotracheal intubation: A randomized study. Ann Anesth Crit Care. 2019 Aug 16;4(1):1-6. doi: 10.5812/aacc.90482

Puchner W, Egger P, Pühringer F, Löckinger A, Obwegeser J, Gombotz H. Evaluation of remifentanil as single drug for awake fiberoptic intubation. Acta Anaesthesiol Scand. 2002 Apr;46(4):350-4. doi: 10.1034/j.1399-6576.2002.460403.x, PMID 11952431

Hassani V, Farhadi M, Mohseni M, Safaeian R, Nikoobakht N, Kashani SS, et al. Comparing the efficacy of dexmedetomidine versus fentanyl and midazolam during awake fiberoptic intubation. Arch Anesthesiol Crit Care. 2018 Sep 11;4(4):538-41.

Yousuf A, Ahad B, Mir AH, Mir AW, Wani JG, Hussain SQ. Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study. Anesth Essays Res. 2017 Oct;11(4):998-1003. doi: 10.4103/aer.AER_150_17, PMID 29284863

Chu KS, Wang FY, Hsu HT, Lu IC, Wang HM, Tsai CJ. The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation. Eur J Anaesthesiol. 2010 Jan 1;27(1):36-40. doi: 10.1097/EJA.0b013e32832e0d2b, PMID 19550337

Patodi V, Upreti B, Sethi SK, Jain N, Gurjar SS. A prospective randomized double blind study to compare the effects of dexmedetomidine and fentanyl on intubating conditions during awake fiberoptic bronchoscopy guided intubation. Indian J Clin Anaesth. 2018 Jul;5(3):415-22.

Published

07-05-2024

How to Cite

GOYAL, G., kiran yadav, Kalpana Verma, N. GUPTA, and Sudhir sachdev. “RANDOMIZED TRIAL FOR COMPARISON OF BUPRENORPHINE AND FENTANYL FOR AWAKE FIBEROPTIC INTUBATION”. Asian Journal of Pharmaceutical and Clinical Research, vol. 17, no. 5, May 2024, pp. 85-89, doi:10.22159/ajpcr.2024.v17i5.50676.

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