Many different protocols of topical anesthesia and sedative agents have been used for fibreoptic intubation in the anticipated difficult airway, and were reviewed in this meta-analysis.
Intubation failure occurred in 0.6%, and severe adverse events in 0.3% with no permanent sequelae or death.
There were no differences in different methods of local anesthesia, and all sedation methods were equivalent.
Desaturation was similar with Remifentanil or Propofol, amd apnea was lower with Sevoflurane vs. Propofol. Desaturation was lower with Dexmedetomidine compared to opioids and Propofol with or without Midazolam.
The authors conclude: A high degree of efficacy and safety was observed with minimal differences among different protocols; dexmedetomidine might offer a better safety profile compared to other sedatives.