Comparison of intubating conditions following dexmedetomidine versus midazolam nebulization during awake fiberoptic intubation.

Background and Aims: Awake fiberoptic intubation (AFOI) is the gold standard for predicted difficult airways. Optimal sedation is crucial for patient comfort and procedural success. Nebulized sedatives offer a noninvasive approach, allowing for titration and rapid cessation if needed. We aimed to compare patient comfort, as reflected by patient reactions during AFOI, following dexmedetomidine versus midazolam nebulization in patients with a predicted difficult airway. The ease of the intubation process and degree of the patient's alertness/sedation were also compared. Material and Methods: It was a prospective randomized, double-blinded study. Fifty patients with predicted difficult airways received either dexmedetomidine 1 μg/kg or midazolam 0.2 mg/kg nebulization. The airway was then topicalized with lignocaine spray, jelly, and a transtracheal block, and AFOI was performed. Following intubation, patients were induced intravenously. Patient comfort, ease of intubation, hemodynamic stability, and adverse events were assessed in both groups and compared. Results: Midazolam nebulization resulted in significantly better patient comfort, as evidenced by lower patient reactions and higher comfort behavioral scores. Both drugs provided adequate sedation for AFOI. The ease of intubation was comparable between the two groups. No significant hemodynamic changes or adverse events were observed. Conclusions: Midazolam nebulization prior to AFOI in patients with a difficult airway provided significantly better patient comfort compared to dexmedetomidine nebulization. The ease of intubation was comparable following nebulization of both drugs.