Potential effect of agomelatine versus dexmedetomidine during awake fiberoptic intubation; role of catacholamine

Background Awake fiber-optic intubation is one of the recommended strategies for surgical patients with suspected difficult airway, especially when simultaneous difficult ventilation is anticipated. Patients and methods In all, 90 patients of both sexes aged between 20 and 55 years, American Society of Anesthesiologist I and II stages were scheduled for elective abdominal surgeries. Patients were randomized into three equal groups. Group A: oral agomelatine at a dose of 10 mg administered with a sip of water 120 min before surgery. Group B: agomelatine+dexmedetomidine. Group C: dexmedetomidine infused at a dose of 1 μg/kg loading infusion per 10 min followed by a continuous infusion of 0.2 μg/kg/h. The following variables (mean arterial pressure, heart rate, oxygen saturation, cough score, postintubation score) and Richmond agitation sedation scale score were recorded in addition to the serum level of norepinephrine. Conclusion Agomelatine is more effective than dexmedetomidine in making better intubation state with sedation, less desaturation, and hemodynamic stability during awake fiber-optic intubation. Synergestic effect between agomelatine and dexmedetomidine was detected.