It has recently been shown that esmolol provided consistent and reliable protection against increase in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation. This study was therefore designed to establish whether esmolol was as effective in controlling the responses to awake fiberoptic tracheal intubation as it was in controlling the responses to traditional intubation and to assess the effect of esmolol for conditions of intubation, sedation, respiratory system during fiberoptic laryngoscopy and intubation.

Thirty patients, ASA physical status I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive preintubation dose of either fentanyl 100 microgram(Group F) or fentanyl 50 microgram and esmolol 100 mg(Group E). And during awake fiberoptic nasotracheal intubation, heart rate, systolic and diastolic arterial pressures, minimal peripheral oxygen saturation, sedation score, intubation condition and time were recorded.

There were no significant differences in arterial blood pressures, sedation score, intubation condition and time. But the change of heart rate in Group E was significantly less at 1 minite and 2 minites after the start of tracheal intubation and in Group F, minimal peripheral oxygen saturation was significantly reduced and two patients in Group F were hypoxemic and apneic.

The present results show that esmolol provides attenuation of the change of heart rate by awake fiberoptic nasotracheal intubation and minimize the risk of apnea and hypoxia due to combination of fentanyl with midazolam.