Preliminary Experience With Dexmedetomidine for Monitored Anesthesia Care During ENT Surgical Procedures

Abstract

Dexmedetomidine is an alpha2-adrenergic agonist that produces anxiolysis, amnesia, sedation, potentiation of opioid analgesia, and sympatholysis. It is currently approved by the U.S. Food & Drug Administration for the sedation of adults in the intensive care setting for up to 24 hours during mechanical ventilation. Given its beneficial sedative and anxiolytic properties and limited adverse effect profile, it has been used in several other clinical scenarios. The authors present their experience using dexmedetomidine for monitored anesthesia care (MAC) during "awake" ENT procedures such as thyroplasty, a procedure requiring a patient to verbalize when requested but to otherwise remain immobile to allow for completion of the procedure, and in a patient with post-polio syndrome with poor pulmonary reserve requiring esophagoscopy with dilation and botulinum toxin injection for cricopharyngeal dysfunction. Our preliminary experience suggests that dexmedetomidine provides effective sedation as the primary agent for MAC during such procedures in adult patients. The end-organ effects of dexmedetomidine and previous reports of its use during MAC are reviewed.

Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea

“…[19] Patients receiving dexmedetomidine can typically respond to commands and perform psychomotor tests when lightly aroused from their sedate state without a need to decrease or stop the dexmedetomidine infusion. [10] In our study, we found that the dexmedetomidine-treated patients were sedated; they appeared to be asleep but were easily aroused with verbal or physical stimuli.…”

Comparison of an Intraoperative Infusion of Dexmedetomidine or Remifentanil on Perioperative Haemodynamics, Hypnosis and Sedation, and Postoperative Pain Control

“…The BIS, VAS scores, modified OAA/S scores of sedation, vital signs, respiratory rates and end-tidal carbon dioxide levels were also measured simultaneously. 15,16 …”

The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

“…Monitored anesthesia care has been widely used in many clinical fields such as gastrointestinal endoscopy, septoplasty, thyroplasty, interventional or radiological procedures, cataract surgery, and awake bronchoscopy intubation (Bekker and Sturaitis, 2005; Busick et al, 2008; Goksu et al, 2008; Dogan et al, 2010; Parikh et al, 2013; Mondal et al, 2015). It can provide suitable intraoperative conditions for both patients and surgeons alike while avoiding the adverse reactions of GA, e.g., hemodynamic instability and prolonged emergence.…”