Efficacy of Nebulized Dexmedetomidine and Lignocaine Inhalation versus Lignocaine Alone as Premedication for Flexible Fiber-optic Bronchoscopy under Sedation: A Randomized Comparative Study.

Abstract

Introduction: Airway management is an integral part of general anesthesia, allowing ventilation and oxygenation and working as a mode for delivering anesthetic gases. Awake fiber-optic-guided intubation is an essential component of airway management in difficult cases. We aim to study the benefits of nebulized dexmedetomidine with lignocaine over lignocaine alone for anesthetizing the airway for flexible fiber-optic bronchoscopy.

Materials and methods: In the study, after written informed consent, 50 patients were randomly allocated into two equal groups of 25 each. The intervention group received dexmedetomidine with lignocaine nebulization, while the control group received lignocaine nebulization alone. Baseline pulse rate, blood pressure, and, at regular intervals, cough, sedation, and pain scores were recorded along with the patient satisfaction score. Parametric data were analyzed by the Student's t-test, while nonparametric data were analyzed by the Wilcoxon Mann-Whitney U test.

Results: Out of a total of 54 patients, 4 patients did not give consent to participate in the study. The demographic profile was comparable in both groups. The pulse rate was comparable in both groups throughout the procedure; however, 10 min after the procedure, the pulse rate in the lignocaine group was (mean ± standard deviation) 114.2 ± 11.52, while in the intervention group, it was 87.32 ± 7.24 with a P = 0.027. The mean blood pressure was comparable throughout the procedure. The cough score yielded a Z-score of -5.12 and a P < 0.00001 favoring the dexmedetomidine group. Similarly, Richmond agitation-sedation score and Visual Analog Scale (VAS) also favored the intervention group, with P < 0.00054 and P < 0.00001 in RASS and VAS, respectively. Patient satisfaction score analysis found a Z-score of -5.29 and a P < 0.00001.

Conclusion: The overall results favored dexmedetomidine with lignocaine nebulization over lignocaine alone for anesthetizing airways for flexible fiber-optic bronchoscopy.