Dexmedetomidine in the Management of Awake Fiberoptic Intubation

Alfieri, Aniello; Passavanti, Maria Beatrice; Franco, Sveva Di; Sansone, Pasquale; Vosa, Paola; Coppolino, Francesco; Fiore, Marco; Aurilio, Caterina; Pace, Maria Caterina; Pota, Vincenzo

doi:10.2174/2589645801913010001

Cited by 8 publications

(4 citation statements)

References 41 publications

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“…Alfieri et al used dexmedetomidine in the management of awake fiberoptic intubation. For its sedative, anxiolytic, analgesic and sympatholytic properties can be a useful drug during awake intubation, reducing patient discomfort, without depressing the respiratory function and having a negligible impact on the cardiovascular system [13]. Cristiano et al have successfully used sedation with dexmedetomidine in patients undergoing transfemoral transcatheter aortic valve implantation procedures.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Pota

Francesco

Crescenzo

et al. 2023

Discov Health Systems

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Background and purpose Stroke is defined as a sudden onset of a neurological deficit caused by an acute focal injury to the central nervous system due to a vascular cause. It represents the second leading cause of death, the third leading cause of disability worldwide and the primary cause of disability in the elderly. Ischemic strokes are the most common (≈85%), the rest (≈15%) are hemorrhagic strokes, that include cerebral and subarachnoid. One of the commonly procedure used in patients with large-vessel occlusion is intra-arterial (IA) recanalization. Moderate conscious sedation (CS) and general anesthesia (GA) with intubation are the most used anesthesia techniques for patients with acute ischemic stroke undergoing endovascular recanalization. Methods In this retrospective observational study, we analyzed data of registry before and after we have changed our sedation protocol from remifentanil/propofol (P/R group) infusion in total intravenous anesthesia (TIVA) to intravenous infusion of dexmedetomidine alone (D group). The primary endpoint was to determine the rate of conversion from CS to GA for each group. The secondary outcomes were the incidence of complications (bradycardia, hypotension, tachycardia, hypertension). Results and conclusion 12 patients in P/R group need the conversion from CS to GA while only 5 patients in D group. There weren't significant differences between the 2 groups respect to heart rate (HR), peripheral oxygen saturation (SpO2) during the procedure, for the good neurological outcome (mRS score < 3, p > .05) and NIHSS score after 48 h (p > .05). There were several organizational and economic advantages with the conscious sedation procedure, such as reduction of occupation time in the operating room and reduction of postoperative Intensive Care Unit (ICU) stay.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Pota

Francesco

Crescenzo

et al. 2023

Discov Health Systems

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“…Both these side effects may result in loss of the airway, which in our case would have necessitated a challenging emergency bronchoscopic tracheal intubation via the oral route, or tracheostomy. Airway reflexes are maintained with dexmedetomidine; therefore, topicalisation of the airway with local anaesthetic is required, as dexmedetomidine does not have the same antitussive properties as remifentanil [9].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine sedation for a dental extraction in a patient with known difficult airway

Guinness

Coleman

Gillbride

2022

Anaesthesia Reports

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Fibrodysplasia ossificans progressiva is an autosomal dominant condition that causes cervical spine fusion and ankylosis of the temporomandibular joint, resulting in anaesthetic challenges. Awake tracheal intubation with flexible bronchoscopy is recommended for general anaesthetics required by patients with this disease. This case report describes the novel approach of using dexmedetomidine sedation in combination with local anaesthesia to allow dental extraction of the fifth and seventh upper left teeth in a patient with fibrodyplasia ossificans progressive, who had a known difficult airway and profound thrombocytopenia. This procedure was not previously tolerated by the patient under local anaesthesia alone. The use of dexmedetomidine was successful in facilitating completion of the procedure with a high degree of patient satisfaction. We discuss the advantages of dexmedetomidine over other sedative agents due to its minimal effects on respiratory drive and airway muscle tone. We highlight the use of dexmedetomidine for complex cases such as this, where tracheal intubation is potentially challenging, but the procedure itself could be managed under sedation and local anaesthesia.

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“…4 Awake fiberoptic intubation under dexmedetomidine infusion is considered optimal. 5 Loss of muscular tone and floppy soft tissues after administration of muscle relaxants may make fiberoptic intubation after induction of anesthesia even more difficult.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Challenges in a Patient of Morquio Syndrome Associated with Acromegaly

Singh

Sarna

Tripathi

et al. 2022

Annals of Neurosciences

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Background Morquio syndrome is one of the rare storage disorders associated with excessive deposition of keratin sulfate and chondroitin-6-sulfate in bones, cartilages, heart valves, and cornea. Although most individuals with this syndrome appear normal at birth; skeletal abnormalities often develop within the first year of life. Restricted breathing, joint stiffness, and cardiac abnormalities are also common. The multisystem involvement in these patients poses unique anesthestic challenges and there is a paucity of literature regarding the anesthetic management of patients with this condition. Case Report We report a successful management of a rare case of 34 years old male with Morquio syndrome who presented an association of acromegaly and was planned for surgical resection of the tumor under general anesthesia. Conclusion Such rare disorders primarily require thorough knowledge about the disease, its presentation and management strategies for a better outcome. Keeping in mind the multisystem involvement a proper teamwork and coordination of various specialities becomes an utmost importance.

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Dexmedetomidine in the Management of Awake Fiberoptic Intubation

Cited by 8 publications

References 41 publications

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Dexmedetomidine sedation for a dental extraction in a patient with known difficult airway

Anesthetic Challenges in a Patient of Morquio Syndrome Associated with Acromegaly

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