Abstract：【Objective】To investigate the efficacy and safety of dextromethorphan and midazolam combined with sufentanil in patients with difficult airway using visible laryngoscopy (glidescope) conscious tracheal intubation.【Methods】Forty patients with difficult airway (Mallampati grade >Ⅲ) from the First Hospital of Changsha were randomly divided into two groups: the dexmedetomidine and midazolam combined with sufentanil (group DM), and the midazolam combined with sufentanil group (group M), with 20 cases in each group. At 15min before tracheal intubation, group DM was treated with dexmedetomidine (1μg/kg) and midazolam intravenous infusion (0.01mg/kg), while group M received intravenous infusion of midazolam 0.02mg/kg. At 5min before intubation group DM and group M were given sufentanil (0.1μg/kg, dilute with saline at 1ug/ml, intravenous drip). After the infusion, patients of two groups underwent thyrocricoid puncture injection of 2% lidocaine (3ml). All patients were selected to be intubation through mouth by gliscope (visible laryngoscopy). Heart rate (HR), systolic blood pressure (SBP),and diastolic blood pressure (DBP) were recorded at entering OR 10min (T0), before thyrocricocentesis (T1), post-thyrocricocentesis (T2), video laryngoscope (T3), and tracheal catheter insert the glottis (T4). Ramsay sedation score of the two groups of patients at T0, T1 and T2 were recorded as well. Lethargy, respiratory depression, hypoxia and cough (choking) in the process of intubation were recorded as well as postoperative hoarseness and incidence of sore throat. 【Results】At T4, the HR, SBP and DBP in group DM were significantly lower than those in group M (P<0.05). In both group DM and group M, the values of HR, SBP and DBP at T1 were significantly lower than those at T0 (P<0.05). The values of HR, SBP and DBP at T4 in group M was significantly higher than those at T0. There was no significant difference in sedation score between the two groups in the T0. The sedation scores at T1 and T2 in group M were higher than those in group DM (P<0.05). In both group DM and group M, the sedation scores at T1 and T2 were significantly higher than those at T0 (P<0.05). The incidence of drowsiness (lethargy) and cough (choking) of group M were significantly higher than those of group DM (P<0.05). There was no significant difference in the incidence of respiratory depression and sore throat between the two groups (P> 0.05). There was no hoarseness in both groups.【Conclusion】Compared to midazolam combined with sufentanil, dexmedetomidine and midazolam combined with sufentanil for patients with difficult airway undergoing visible laryngoscopy (glidescope) conscious tracheal intubation has more advantages. It can keep blood pressure and heart rate more stable and lowering incidence rate of drowsiness, cough (choking), and other adverse reactions.
[1] Coull JT, Jones ME, Egan TD,et al. Attentional effects of noradrenaline vary with arousal level:selective activation of thalamic pulvinar in humans[J].Neuroimage,2004,22(1):315-322.
[2] Afonso J.Dexmedetomidine:current role in anesthesia and intensive care[J].Rev Bras Anestesiol,2012,62(1):118-133. [3] Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-ppromoting pathway to exert its sedative effects[J].Anesthesiol,2003,98(2):428 -436. [4] Ramsay MA, Savege TM, Simpson BRJ, et al. Controlled sedation with alphaxalone-alphadolone[J].Br Med J,1974,2(5920):656-659. [5] Bhana NL,Goa kl. Dexmedetomidine[J].Drugs,2000,59(2):269-270. [6] Lam SW, Alexander E. Dexmedetomidine use in criticalcare[J].AACN Adv Care,2008,19(1):113. [7] Bhana N, Goa KL, Mcclellan KJ. Dexmedetomidine[J].Drugs,2000,59(2):263-268. [8] Wijeysundera DN. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis[J].Am J Med,2003,114(9):742-752. [9] Bergese SD, Candiotti KA, Bokesch PM, et al. A phase Ⅲb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation[J].Am J Ther,2010,17(6):586-595. [10] Bergese SD,Patrick Bender S,Mcsweeney TD,et al.A comparative study ofdexmedetomidine with midazolam alone for sedation during elective awake fiberoptic intubation[J].J Clin Anesth,2010,22(1):35-40. [11] Wakita R, Kohase H, Fukayama H. A comparison of dexmedetomidine sedation with and without midazolam for dental implant surgery[J].Anesth Prog,2012,59(2):62-68.
2017, Vol. 34 
