Comparison of Remifentanil with a Combination of Remimazolam and Dexmedetomidine for Awake Tracheal Intubation
Comparison of the Safety and Effectiveness of Remifentanil with a Combination of Remimazolam and Dexmedetomidine for Awake Fibreoptic Nasotracheal Intubation
Nanjing First Hospital, Nanjing Medical University
60 participants
Sep 19, 2024
INTERVENTIONAL
Conditions
Summary
Awake fiberoptic intubation (AFOI) requires airway surface anesthesia to inhibit pharyngeal reflex, glottis closure reflex, and cough reflex. Additionally, the use of sedative drugs can enhance patient comfort and tolerance, reduce anxiety, and eliminate harmful effects on systemic hemodynamics.The objective of this study is to compare the safety and efficacy of remifentanil alone versus a combination of dexmedetomidine and remifentanil for sedation during conscious tracheal intubation.
Eligibility
Inclusion Criteria4
- Patients undergoing general anesthesia who require awake nasal tracheal intubation.
- Age 18-65 years old
- ASA classifications of I-III
- BMI<30kg/m2
Exclusion Criteria9
- Patients allergic to propofol, midazolam, dexmedetomidine, remifentanil.
- Second- or third-degree atrioventricular block, rate <50 beats/min, systolic blood pressure <90 mmHg
- Acute exacerbation of respiratory diseases such as asthma, bronchitis, and chronic obstructive pulmonary disease (COPD)
- Patients with acute arrhythmias and severe heart disease (congenital, valvular diseases)
- Patients with severe liver or kidney dysfunction requiring replacement therapy
- Patients with severe mental disorders requiring medication for symptom control and experiencing communication barriers
- Patients with moderate to severe anemia, coagulation disorders, and hematologic diseases
- Patients with basal skull fractures, facial fractures, significantly deviated nasal septum, or nasal cavity diseases causing severe nasal congestion
- patients on long-term opioids or sedative medication
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Interventions
Patients in this group will receive a bolus of remimazolam 5 mg intravenously, and then a dose of 0.1 μg/kg/min remifentanil and 0.5 mg/kg/h remimazolam via separate syringe pumps.
Patients in this group will receive a loading dose of dexmedetomidine 1 μg/kg over 10 minutes intravenously, and then a dose of 0.1 μg/kg/min remifentanil and 0.5 μg/kg/h dexmedetomidine via separate syringe pumps.
Locations(1)
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NCT06581731