An ideal sedative should have a fast onset and offset of drug efficacy, be predictable and titratable, and have no serious side effects. Additionally, low price burden is preferable.Dexmedetomidine is a selective α2-adrenergic receptor agonist and is known to be a safe sedative that causes little respiratory depression [1]. It is characterized by "conscious sedation" and a clean and easy arousal from sedation, similar to being awakened by natural sleep [2]. Despite its expanded use within variable populations for procedural sedation, life-threatening pulmonary aspiration associated with dexmedetomidine has rarely been reported in cases of procedural sedation [3]. However, dexmedetomidine has some disadvantages, such as slower onset, frequent in-procedural awakenings, hemodynamic instability, and longer stay in postoperative care units [4,5]. Recently, "balanced sedation" has been introduced as an alternative strategy to increased doses of dexmedetomidine. Some sedatives or opioids such as ketamine, midazolam, or other opioids (e.g., remifentanil infusion) can be co-administered. However, the coadministration of other drugs can not guarantee the complete safety [6,7].We describe a case of fatal pulmonary aspiration that developed in balanced sedation with dexmedetomidine and a small amount of midazolam during spinal anesthesia in an elderly patient. CASE REPORTThe patient was an 84-year-old male (155 cm in height and 52 kg in weight) with a history of hypertension and kyphoscoliosis. He was transferred to our trauma center because of periprosthetic fracture of the left hip. He had undergone hip hemiarthroplasty 4 years ago and again fractured at the same position. He had cane-assisted ambulation prior to surgery and was relatively healthy for his age. Following routine preoperative examinations, including laboratory investigations,
Background Tracheostomy tube exchange is a common and safe procedure. However, when the tracheocutaneous tract is not completely mature, cannula exchange or endotracheal tube insertion via the tracheostomy site can rarely induce life-threatening complications, including subcutaneous emphysema, loss of airway, tension pneumothorax, and pneumoperitoneum. Case We report a case of life-threatening tension pneumothorax developed during tracheostomy tube exchange with a reinforced endotracheal tube for a planned facial surgery after recent tracheostomy in a trauma patient. Conclusions Understanding of the pathogenesis and the use of preventive strategies based on it are expected to provide safer and more effective anesthetic management to patients with tracheostomy.
Background Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it. Case We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature. Conclusions There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.
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