关键词: 右旋美托咪定；困难气道；巨大甲状腺肿；丙泊酚；纤维支气管镜

Abstract:

Objective
To study the effectiveness of dexmedetomidine combined with fibreoptic bronchoscope for tracheal intubation in difficult airways caused by huge goiter.Methods Thirty patients with  anticipated difficult airways caused by huge goiter were enrolled and randomly divided into dexmedetomidine group (n=15) and propofol group (n=15).The patients in dexmedetomidine group received a loading dose of dexmedetomidine (1.0 μg?kg-1),infused over 10 min,then pumped at continuous rate of 0.4 μg.kg^-1.h^-1.The patients in propofol group received a loading dose of 2.0 mg.kg^-1 and pumped at continuous rate of 5-8  mg.kg^-1.h^-1. The intubating conditions  were graded by a scoring system; the reactions to intubation such as coughing and patient tolerance were observed;the heart rates and mean arterial blood pressures (MABP) at different time points of baseline(T0),Rassay score 4(T1),intubating(T2),1 min after intubation (T3) and 3 min after intubation (T4) were recorded;adverse events and haemodynamic support were observed.Results  All the  patients in two groups were performed successfully with fibreoptic intubation.The patients in dexmedetomidine group  could keep better spontaneous breathing without respiratory depression,and were able to command and cooperate tracheal intubation,while in propofol group 11 patients (73.3%) could not cooperate tracheal intubation (P<0.05).With respect to intubation scores in propofol group,there were 7 cases of  vocal cord opening and 3 cases of  vocal cord movement;while in dexmedetomidine group,there were 12 cases in vocal cord opening and 3 cases in vocal cord moving.Compared with propofol group,the patients in dexmedetomidine group had more favorable intubation scores of  vocal cord movement (P<0.05).With respect to no reaction or slight grimacing of reaction to intubation comfort score,there were 8 cases in propofol group and 12 cases in dexmedetomidine group,and there was significant difference (P<0.05).The patients in dexmedetomidine group experienced fewer airway events and less heart rate response to intubation than those in  propofol group (P<0.05).Conclusion Compared with propofol in management of difficult airways caused by huge goiter,dexmedetomidine has better tolerance,and preserves a patient airway,and has more stable haemodynamic response to intubation.
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Key words: dexmedetomidine;difficult airway;huge goiter;propofol;fibreoptic bronchoscope