الفهرس 
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Abstract
Awake Fiberoptic Intubation (AFOI) is indicated for patients with an anticipated difficult airway because of their anatomy, airway trauma, morbid obesity and unstable cervical spine injuries. The term ”AFOI” is used to distinguish this procedure from fiberoptic intubation performed during general anesthesia
One challenge associated with this procedure is providing adequate anxiolysis while maintaining a patent airway and adequate ventilation, especially with difficult or critical airways, where strict attention must be paid to the drugs used to achieve sedation and analgesia
Benzodiazepines combined with opioids are commonly used during AFOI. Unfortunately, this combination of drugs can cause respiratory depression, placing the patient at risk for hypoxemia and aspiration
Dexmedetomidine is a centrally acting, highly selective α2 agonist which has gained increasing popularity since 1999 as a drug for sedation in ICU settings. It has also been used for intraoperative sedation during surgery under regional anesthesia and for awake craniotomies, as well as for sedation of pediatric patients in different settings
Dexmedetomidine has several unique properties making it ideally suited for the management of difficult airways. First, it provides a unique form of sedation in which patients appear to be sleepy but, if stimulated, are easily aroused, cooperative and communicative
Second, dexmedetomidine has anxiolytic, amnestic and moderate analgesic effects as well as antisialogogue effects Third, dexmedetomidine has a respiratory-escape effect, even when given in large doses
Previous studies had demonstrated the use of dexmedetomidine for sedation during fiberoptic intubation.
So, this study was designed to evaluate the efficacy and safety of dexmedetomidine as a sole sedative during AFOI in patients with difficult airways, compared to the conventionally used fentanyl/midazolam combination and propofol/midazolam combination
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