Comparative efficacy of different doses of dexmedetomidine in sedation during awake fibreoptic nasotracheal intubation: A systematic review and meta-analysis.

Abstract

Background and aims: Awake fibreoptic nasotracheal intubation (AFONI) is critical in patients with difficult airways, requiring effective sedation that preserves spontaneous ventilation and airway reflexes. This systematic review evaluated the comparative efficacy of various dexmedetomidine doses in sedation for AFONI, with a meta-analysis focusing on 0.5, 1, and 1.5 µg/kg doses.

Methods: Databases searched included PubMed, EMBASE, Web of Science, and Cochrane, initially up to 5 May 2024, with a top-up search on 15 April 2025. Five studies were systematically reviewed, covering dexmedetomidine doses of 0.5, 0.7, 1, 1.5, and 2 µg/kg. A meta-analysis was conducted on two studies with doses of 1 and 1.5 µg/kg, and two studies with doses of 0.5 and 1.5 µg/kg. Primary outcomes included patient comfort, intubation scores, and sedation levels; secondary outcomes included vocal cord function, cough, and limb movements. Continuous and dichotomous outcome variables were summarised as mean difference and risk ratio, with a 95% confidence interval, using RStudio 2024.12.0 (PROSPERO ID: CRD42024541481).

Results: Meta-analysis showed that 1.5 µg/kg did not significantly improve patient comfort or intubation conditions compared to 1 and 0.5 µg/kg. No significant differences were observed in intubation comfort scores, sedation levels, or patient satisfaction across the various doses.

Conclusions: Dexmedetomidine at 0.5 and 1 µg/kg offers effective sedation and patient comfort comparable to 1.5 µg/kg during AFONI. Given the very low to moderate certainty of evidence, further large-scale studies are warranted to establish optimal dosing for enhanced patient experience and reduced side effects across various clinical settings.