A Randomized Study to Compare Efficacy of Combination of Dexmedetomidine and Midazolam versus Fentanyl and Midazolam in Head and Neck Cancer patients for Awake Flexible Nasotracheal Intubation in Department of Anaesthesia SMS Medical College Jaipur

Awake nasotracheal intubation is recommended technique for securing airway in patients with anticipated difficult intubation while keeping the patient concious but sedated with intact respiratory drive to ensure better patient comfort and cooperation during the procedure.This study aims to compare the efficacy of combination of Dexmedetomidine and Midazolam versus Fentanyl and Midazolam in head and neck cancer patients for awake flexible nasotracheal intubation. For this a total of eighty four patients ( n=84) undergoing surgery for head and neck cancer fulfilling the inclusion criteria will be divided into two groups of 42 patients each Group A and B. Group A patients will be receiving Midazolam 0.03mg/kg and an infusion of Dexmedetomidine 1mcg/kg diluted in 50 ml saline over 10 minutes whereas group B will be receiving Midazolam 0.03mg/kg and an infusion of Fentanyl 2mcg/kg diluted in 50 ml saline over 10 minutes. Level of sedation will be assessed using modified Observers Assessment of Alertness Sedation Score (OAA/S) . After adequate Sedation intubation will be done using flexible bronchoscope and the position of endotracheal tube will be confirmed by end tidal capnography . Anaesthesia will be induced and maintained. After completion of the surgery all anaesthetic agents will be withdrawn , residual neuromuscular block will be reversed with injection Neostigmine 0.06mg/kg and injection Glycopyrrolate 0.001mg/kg . Patient will be extubated when fully awake having good motor power and obeying verbal commands following which the patient will be shifted to recovery room and monitored. 2 hours post extubation patient will be evaluated for recall of the procedure.