Sevoflurane sedation as an alternative for awake fiberoptic intubation in difficult airway patients: a randomized controlled trial.

Background: Fiberoptic intubation is recommended for difficult airways, but traditional awake techniques can cause patient discomfort. This study compared sevoflurane sedation to conventional awake fiberoptic intubation (AFOI) in difficult airway patients.

Methods: Seventy participants with difficult airways were involved in an open label randomized controlled trail. Patients were randomized to undergo fiberoptic intubation under either sevoflurane sedation with 2% with a gradual increase in concentration while maintaining spontaneous breathing (group I) or AFOI with airway nerve blocks with bilateral superior laryngeal nerve blocks and transtracheal instillation using 2% plain lidocaine (2 ml each) (group II).

Results: Group I had a substantially reduced intubation time (4.51±1.09 vs. 6.74±1.09 minutes, P<0.001). Group I showed better hemodynamic stability and superior intubation scores, with less coughing (P=0.003) and limb movement (P<0.001). Patient comfort was higher in group I than in group II (74.29 vs. 31.43%, P=0.021). Group I had higher patient satisfaction, 91.43% vs. 68.57% in group II (P=0.034) and fewer complications, including airway obstruction (40% vs. 71.43%, P=0.008) and cough (25.71% vs. 62.86%, P=0.002).

Conclusions: Sevoflurane sedation appears to be an effective alternative to AFOI in difficult airway patients, offering shorter intubation times, improved hemodynamic stability, better intubation conditions, and higher patient satisfaction.