Introduction: Securing a difficult airway is pivotal during anesthesia, with the risk of severe complications driving the need for effective intervention. Awake fiberoptic intubation (AFOI) often necessitates sedatives, which can cause airway obstruction. This clinical trial compared the use of nebulized dexmedetomidine with ketamine, combined with lignocaine, to improve patient comfort and procedural effectiveness for AFOI while minimizing side effects. Materials and Methods: In this prospective randomized controlled trial, 60 patients with difficult airways were assigned to one of two groups. Group 1 received nebulized dexmedetomidine (1 μcg/kg) with 2% lignocaine, and Group 2 received nebulized ketamine via nebulizer (3 mg/kg) with 2% lignocaine. The primary outcome measure was the ease of intubation, and secondary outcomes included cough severity and glottic conditions during the procedure. Results: The dexmedetomidine cohort saw a marked improvement in intubation ease and reduced coughing severity, showing a significant contrast to the ketamine group. Specifically, 70% in the dexmedetomidine group reported easy intubation versus 33.3% in the ketamine group, with reduced instances of moderate to severe coughing (20% vs. 50%). Both groups maintained hemodynamic stability. The favorable outcomes observed with nebulized dexmedetomidine can be attributed to its unique pharmacological properties, including anxiolysis, analgesia, and antisialagogue effects, all of which are desirable for AFOI. Conclusion: Nebulized dexmedetomidine with lignocaine proved to be a more effective regimen than ketamine with lignocaine for AFOI, improving patient comfort and ease of procedure without compromising safety. This study highlights the advantageous pharmacological profile of dexmedetomidine, underscoring its potential for airway management in anesthesia. Further research is needed to validate these results and explore wider clinical applications.
Sharma et al. (2026) studied this question.