Propofol for Conscious Sedation for Fibreoptic Nasotracheal Intubation: Comparison with Fentanyl - Midazolam Combination

The safest way of doing fibreoptic intubation is with the patient under conscious sedation and maintaining spontaneous respiration. Short acting and easily titrable analgesics are excellent choices for the intensely , but usually brief airway manipulation during fibreoptic nasotracheal intubation .This study was undertaken to evaluate the efficacy of propofol for conscious sedation for FOI and to compare it with a combination of fentanyl and midazolam which is frequently used for this purpose. The parameters studied were, the quality of sedation, intubating conditions, haemodynamic changes, degree of amnesia and global acceptance of the procedure under topical anaesthesia. In our study, we found that in the doses used by us, propofol produced comparable intubating conditions as a combination of midazolam and fentanyl. It produced significantly more sedation but difference between the two groups was significant only at 2 minutes (p value=0.028). Propofol leads to less increase in heart rate when the fiberscope was inserted endotracheally (P value=.007) .As the procedure progressed more boluses of propofol were needed to continue with the procedure. The degree of amnesia for the procedure was less with propofol however; the degree of global acceptance was comparable. To conclude propofol can be used for nasotracheal fibreoptic intubation, however its role in difficult airway and the dose required need more evaluation.