Sedation with Dexmedetomidine Infusion versus Superior Laryngeal Nerve Block for Awake Fiberoptic Intubation of Hemimandibulectomy Patients with an Anticipated Difficult Airway: A Randomized Controlled Trial

Background: Dexmedetomidine’s analgesic and anxiolyt-ic effects, along with its capacity to produce a sedative effect without respiratory depression, make it a popular choice among anesthesiologists for sedation during awake fiberoptic intuba-tion (AFOI). Aim of Study: The study aimed to assess the safety and efficacy of dexmedetomidine infusion and superior laryngeal nerve block (SLNB) for conscious sedation during AFOI in hemimandibulectomy patients. Patients and Methods: This randomized controlled re-search was performed on 80 cancer cases between the ages of 18 and 60 belonging to the American Society of Anesthesiolo-gists physical status II, III, body mass index 18.5 to 30kg/m2, hemi-mandibulectomy with an anticipated difficult airway [El-Ganzouri Risk Index >3]. They were divided into two equal groups of patients: Group 1: Received 0.5mcg /kg dexmedeto-midine over 10min via syringe pump, after that 0.2-0.7mcg/kg/ hour till the end of intubation, and Group 2: Received an airway nerve block through bilateral SLNB and trans-tracheal injection for recurrent laryngeal nerve. Results: The intubating conditions score was more favora-ble in Group 1 than in Group 2 with a p-value of 0.001. Ramsay sedation score was deeper in Group 1 than in Group 2 with a statistically significant difference (4±0.00 vs. 2.78±0.48, re-spectively, p<0.001). The degree of airway obstruction and the Patient satisfaction score didn’t show a significant difference between both groups. Both groups showed Haemodynamic sta-bility throughout the procedure. Conclusions: Dexmedetomidine provides safe and good intubating conditions required for AFOI compared to SLNB providing an excellent alternative to SLNB in case of anatom-ical difficulties.Research and ethics committee approval number: ID: MS-48-2023. Clinical Trials Registration ID: NCT06651905.