Related Experiment Video

Updated: May 20, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Dexmedetomidine versus Remifentanil for Sedation during Awake Fiberoptic Intubation

Davide Cattano1, Nicholas C Lam, Lara Ferrario

  • 1Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, TX 77030, USA.

Anesthesiology Research and Practice
|July 31, 2012
PubMed

Insights

Remifentanil demonstrated a higher first-attempt success rate for awake fiberoptic intubation (AFOI) compared to dexmedetomidine. Dexmedetomidine required more time for sedation and resulted in poorer memory recall during AFOI.

Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Airway Management

Background:

  • Awake fiberoptic intubation (AFOI) is a critical technique for managing difficult airways.
  • Sedation is essential for patient comfort and cooperation during AFOI.
  • Comparing sedative agents like remifentanil and dexmedetomidine is important for optimizing AFOI protocols.

Purpose of the Study:

  • To compare the efficacy and safety of remifentanil versus dexmedetomidine for sedation during awake fiberoptic intubation.
  • To evaluate key parameters including time to sedation, intubation success rates, and patient recall.

Main Methods:

  • A double-blinded, randomized pilot study involving 34 adult patients (ASA I-III).
  • Patients received either remifentanil (REM) or dexmedetomidine (DEX) for sedation during nasal or oral AFOI.
  • Data collected included time to sedation, Ramsay Sedation Scale (RSS), Bispectral Index (BIS), and memory recall.

Main Results:

  • First-attempt success rate for AFOI was significantly higher in the remifentanil group (72%) than the dexmedetomidine group (38%).
  • The dexmedetomidine group experienced longer times to achieve adequate sedation (RSS ≥3) and reduced brain activity (BIS <80).
  • Patients receiving dexmedetomidine reported poorer verbal recall post-sedation.

Conclusions:

  • Remifentanil appears more effective for achieving rapid sedation and higher first-attempt success rates in AFOI.
  • Dexmedetomidine may be a useful adjunct but requires careful dosage and timing optimization for AFOI.
  • Further research is warranted to fully elucidate the role and optimal use of dexmedetomidine in AFOI procedures.

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...