Abstract:Objective To investigate the sedative effect and tolerability of dexmedetomidine in patients with difficult airway during fiberoptic bronchoscopy-assisted awake nasotracheal intubation through nebulized inhalation and intravenous pumping. Methods A total of 88 patients who needed to undergo conscious tracheal intubation and general anesthesia from January 2023 to March 2024 in Ma’anshan People’s Hospital were randomly divided into two groups. The patients in control group（n=44）received intravenous pumping of dexmedetomidine（1 μg/kg）, and the patients in experimental group（n=44）received nebulized dexmedetomidine inhalation（1 μg/kg）. The following indicators were recorded: the cough degree of the patient during intubation, the Ramsay sedation score after the completion of dexmedetomidine administration, the mean arterial pressure（MAP）and heart rate at the time of admission（T0）, after dexmedetomidine treatment（T1）, 5 min, 10 min, and 15 min after intubation（T2, T3, T4）, intubation comfort scores and patient satisfaction scores, and the adverse reactions such as bradycardia, hypotension, hypoxemia and so on. Results All patients in both groups were successfully intubated. The experimental group surpassed the control group in the degree of cough severity, Ramsay sedation score, intubation comfort and satisfaction scores（Z=3.508, 4.168, 3.392, 2.759, P<0.01）. Compared with the control group, the heart rate at T3-T4 and the MAP at T2-T4 in the experimental group were significantly increased（P<0.05）. The incidences of bradycardia（11.4% vs 36.4%, χ2=7.568, P<0.01）, hypotension（6.8% vs 27.3%, χ2=6.510, P<0.05）and sore throat（18.2% vs 47.7%, χ2=8.692, P<0.01）in the experimental group were significantly lower than those in the control group. Neither hypoxemia or swallowing difficulties occurred in patients of both groups during the surgical procedure. Conclusion For patients undergoing fiberoptic bronchoscope-guidedtracheal intubation in the awake state, nebulized dexmedetomidine inhalation provides more ideal sedation, better tolerance, and fewer adverse reactions compared to intravenous pumping.