Comparative efficacy of different doses of dexmedetomidine in sedation during awake fibreoptic nasotracheal intubation: A systematic review and meta-analysis
Bibliographic record
Abstract
Background and Aims: Awake fibreoptic nasotracheal intubation (AFONI) is critical in patients with difficult airways, requiring effective sedation that preserves spontaneous ventilation and airway reflexes. This systematic review evaluated the comparative efficacy of various dexmedetomidine doses in sedation for AFONI, with a meta-analysis focusing on 0.5, 1, and 1.5 µg/kg doses. Methods: Databases searched included PubMed, EMBASE, Web of Science, and Cochrane, initially up to 5 May 2024, with a top-up search on 15 April 2025. Five studies were systematically reviewed, covering dexmedetomidine doses of 0.5, 0.7, 1, 1.5, and 2 µg/kg. A meta-analysis was conducted on two studies with doses of 1 and 1.5 µg/kg, and two studies with doses of 0.5 and 1.5 µg/kg. Primary outcomes included patient comfort, intubation scores, and sedation levels; secondary outcomes included vocal cord function, cough, and limb movements. Continuous and dichotomous outcome variables were summarised as mean difference and risk ratio, with a 95% confidence interval, using RStudio 2024.12.0 (PROSPERO ID: CRD42024541481). Results: Meta-analysis showed that 1.5 µg/kg did not significantly improve patient comfort or intubation conditions compared to 1 and 0.5 µg/kg. No significant differences were observed in intubation comfort scores, sedation levels, or patient satisfaction across the various doses. Conclusions: Dexmedetomidine at 0.5 and 1 µg/kg offers effective sedation and patient comfort comparable to 1.5 µg/kg during AFONI. Given the very low to moderate certainty of evidence, further large-scale studies are warranted to establish optimal dosing for enhanced patient experience and reduced side effects across various clinical settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.038 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".