Fentanyl versus Dexmedetomidine as an Adjuvant to Propofol for Fiberoptic Intubation in Patients with Temporomandibular Joint Ankylosis

Background: This study is done in Sohag University Hospitals, Faculty of medicine,sohag university as a collaboration between maxillofacial, head, and neck surgery unit in the general surgery department and anesthesia department.Fiberoptic intubation is the magic technique for difficult airway management in patients of difficult intubation especially in cases of temporomandibular joint ankylosis. Objective: This study aimed to compare the clinical efficacy and safety of premedication with (dexmedetomidine versus fentanyl ) added to propofol infusion for fiberoptic intubation. Patients and Methods: 60 adult patients aged from 20 to 50 years with temporomandibular joint ankylosis, allocated for gap arthroplasty operation. They were enrolled for this prospective randomized clinical trial with two equal groups with 30 patients in each group. Group (D) patients received dexmedetomidine (1μg/kg infused over 10 min ) followed by sedative propofol infusion and Group (F) patients were given fentanyl (2 mcg/kg over 10 min) infused followed by propofol infusion to achieve sedation. Condition achieved endoscopy, intubating conditions, and Stress response including (hemodynamic changes and cortisol level) postoperative complications were evaluated. Results : The fiberoptic intubation was successful with good satisfaction with endoscopy and intubating conditions in both groups. Dexmedetomidine as premedication has provided satisfactory conditions for fiberoptic intubation more than fentanyl group and hemodynamic stability response of fiberoptic intubation than the fentanyl group. Conclusion: Fiberoptic intubation was found to be easier with dexmedetomidine as premedication with a sedative infusion of propofol with complete amnesia of the procedure, with hemodynamic stability and good control of the airway.