Case report
Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases

https://doi.org/10.1016/j.jclinane.2003.05.010Get rights and content

Abstract

We report three patients undergoing cervical spine surgery who required awake fiberoptic intubation, and in whom sedation was provided using a dexmedetomidine infusion. Dexmedetomidine was used to provide a moderate level of sedation without causing respiratory distress or hemodynamic instability during fiberoptic intubation. Conditions for intubation were acceptable in all three patients after co-administration of topical anesthesia. Dexmedetomidine may serve as a useful adjunct for this procedure. The anesthetic management and anesthetic implications of using dexmedetomidine infusions for awake fiberoptic intubation are discussed.

Introduction

Dexmedetomidine is indicated as a sedative in intensive care. Like clonidine, it is a centrally acting alpha2-adrenoceptor agonist. Clonidine has an α1:α2 receptor selectivity ratio of 1:250, and dexmedetomidine has an α1:α2 receptor selectivity ratio of 1:1620. Clonidine has a t1/2β of 10 hours and dexmedetomidine has a t1/2β of 2 hours. Clonidine is principally an antihypertensive, whereas dexmedetomidine is principally a sedative. Dexmedetomidine has been shown to facilitate extubation in the intensive care setting.1 It provides sedation and analgesic sparing effects without evidence of respiratory depression.2 The fact that dexmedetomidine infusion results in a combination of sedation and minimal respiratory depression led us to believe that dexmedetomidine may be an ideal sedative drug to use during fiberoptic intubation. We report three cases in which we used dexmedetomidine for sedation during fiberoptic intubation, and we discuss their management.

Section snippets

Case 1

A 37-year-old man (64 kg, 180 cm) presented for posterior cervical spine fusion and open reduction plus internal fixation of a fractured right radius and ulna following a motor vehicle accident. The patient was wearing a halo neck brace. Other than the injuries noted above, the patient was healthy. His preoperative laboratory data and electrocardiogram were within normal limits. We discussed the anesthetic management with the patient and informed him that he would undergo an awake fiberoptic

Discussion

These three cases demonstrate the successful use of an IV dexmedetomidine load and infusion to provide sedation and analgesia for awake, fiberoptic tracheal intubation. Although there are many techniques for fiberoptic intubation, and there is debate over their relative merits, still there is consensus on the importance of several basic principles. Spontaneous ventilation with patient cooperation should be maintained throughout the surgery.4 Second, adequate topical and regional anesthesia are

References (11)

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    Citation Excerpt :

    Sedation may be provided by judicious use of small doses of benzodiazepine (midazolam 0.03 mg/kg) and opioid (fentanyl 2 μg/kg) that results in a calm, comfortable and cooperative patient. Dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist, is a useful adjunct for awake intubation because of its sedative, analgesic, and anxiolytic properties without respiratory depression [8]. A loading dose (1 μg/kg over 10 min) provides procedural sedation for fiberoptic nasotracheal intubation [9].

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Disclosure statement: Dr. Grant has received unrestricted educational grant from Abbott Laboratories Inc.

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Assistant Clinical Professor of Anesthesiology

Certified Registered Nurse-Anesthetist

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