Comparative efficacy and safety of dexmedetomidine and midazolam for conscious sedation in blind nasotracheal intubation: a randomized controlled trial

Objective To evaluate the safety and efficacy of dexmedetomidine amnestic analgesia slow induction for blind nasotracheal intubation (BNTI) in oral and maxillofacial surgery. Methods Sixty patients undergoing oral and maxillofacial surgery were randomly divided into the dexmedetomidine (DEX) group (1.0 μg/kg, 15 min of infusion + pethidine 1.0 mg/kg) and the midazolam (MID) group (0.02 mg/kg + pethidine 1.0 mg/kg). The intubation time was recorded, and heart rate (HR), mean arterial pressure (MAP), bispectral index (BIS) and pulse oximeter oxygen saturation (SpO 2 ) were monitored at T0 (before induction), T1 (before intubation) and T2 (after intubation). Cortisol (Cor), norepinephrine (NE), epinephrine (E) and beta-endorphin ( β -EP) levels were detected at T0, T3 (3 min after intubation) and T4 (15 min after intubation). The intraoperative fentanyl dosage, end-tidal carbon dioxide partial pressure (P ET CO 2 ) were recorded, and postoperative numerical rating scale (NRS) score, satisfaction and adverse reaction incidence were evaluated. Results Compared with the MID group, the intubation time in the DEX group was shorter and the P ET CO₂ was lower ( p < 0.05). In the DEX group, BIS and HR were lower at T1-T2 ( p < 0.001), and the levels of Cor, NE, E, and β-EP were lower at T3-T4 ( p < 0.05). The dosage of sufentanil, the postoperative NRS score, and adverse reactions (nausea, vomiting, respiratory depression) were reduced in the DEX group ( p < 0.05), and the awakening and extubation time were shorter ( p < 0.05), but there was no difference in the incidence of sore throat and other symptoms ( p > 0.05). Conclusion Dexmedetomidine used for blind nasotracheal intubation for oral and maxillofacial surgery can provide comprehensive anesthesia effects, significantly reduce the stress response of tracheal intubation and the dosage of intraoperative opioids, while maintaining good hemodynamic stability.