Efficacy of Dexmedetomidine for Awake Bronchoscopy in a 3-month Infant with Severe Subglottic Stenosis and Pneumothorax due to Cervical Cystic Lymphangioma
Saito, K.; Toyama, H.; Ejima, Y.; Haitani, A.; Yamauchi, M.
Masui. Japanese Journal of Anesthesiology 65(10): 1026-1030
2016
ISSN/ISBN: 0021-4892 PMID: 30358280 Document Number: 690567
A 3-month-old female infant was admitted because of tachypnea and retractive breathing. Chest X-ray and computed tomography demonstrated right pneumo- thorax and severe subglottic stenosis. She was sched- uled for chest drainage and diagnostic fiberoptic bron- choscopy (FOB), and securing airway by tracheal intubation or tracheostomy. Continuous infusion of dexmedetomidine(DEX, 1.25 iμ · kg(-1) · hr(-1))was started and it was increased to 3.75,μg · kg(-1) · hr(-1) ten min- utes later. Chest drainage was performed with regional anesthesia under deep sedation and she responded only to painful stimulus. After the completion of the chest drainage, chest X-ray revealed the expansion of her right lung. Then, FOB was performed under regional anesthesia with DEX sedation. Moderate sub- glottic stenosis under spontaneous breathing, and the disappearance of the stenosis under positive pressure ventilation was observed by FOB. FOB findings sug- gested that she had acquired tracheomalacia due to external compression by cervical cystic lymphangioma. Therefore, to avoid deterioration of her tracheomalacia, we did not perform tracheal intubation or tracheos- tomy, which could provoke tracheal edema, deforma- tion and subsequent further deterioration of airway stenosis. Although the dose of DEX was higher than the rec- ommended dose, high dose DEX led to adequate seda- tion and analgesia for pediatric FOB without respira- tory distress or hemodynamic instability. We believe that DEX is useful for an infant with difficult airway requiring preservation of airway smooth muscle tone and spontaneous breathing.