Patients in fentanyl and propofol group (Group I) felt more comfortable during AFOI
than nalbuphine and propofol group (Group II).
Introduction of the fibreoptic bronchoscope (FOB) and visualization of the glottis usually reveals a quiet nonreactive larynx, and AFOI
can proceed with no further supplementation of LA, making this technique quick and safe as the period of time for which the airway is unprotected is minimised.
AFOI is deemed best practice to secure these patients' airway.
However, AFOI in FSS frequently can present a significant challenge, even for experienced practitioners (Figure 1).
Furthermore, the authors did not describe the experience of intubators in the AFOI. The experience and competence with the airway procedures are critical for their successful use, especially when there is a difficult airway.
In this study, coughing during AFOI occurred in 40% of patients in dexmedetomidine group and 24% of patients in sufentanil group, respectively.
In view of existing controversies and lack of consensus in previous literatures, this study was carried out over a one year period with the principal aim of comparing dexmedetomidine  alone with fentanyl-midazolam combination as an ideal agent for providing sedation for AFOI
. In this study, we have shown that Dexmedetomidine  convincingly is a superior and better drug in terms of providing sedation for awake fiberoptic intubation in all aspects.
We are very sorry not to define clearly intubation score, a multiple-factor variable including the ease of AFOI, scores of patient reaction and coughing during AFOI.[sup] In our study, power analysis of sample size was actually performed according to patients' reaction scores, rather than intubation score.
Finally, in available literature, a loading dose of dexmedetomidine ranging from 0.4 to 1.5 [micro]g/kg has been used for sedation combined with or without midazolam for AFOI. However, there is not information regarding hypnotic synergism of dexmedetomidine and midazolam when using them together.
Two experienced consultant anesthetists clinically managed the trial: One mainly responsible for performing the procedure of AFOI and the other mainly for observation and data collection.
Thereafter, vital signs were recorded every minute until the completion of the AFOI. Hypotension was defined as SBP <80 mmHg, diastolic blood pressure (DBP) <50 mmHg, or a SBP decrease to ≥30% below baseline.