[Airway management with dexmedetomidine for difficult airway]

Dexmedetomidine has the advantage of producing sedation accompanying patient's cooperation without respiratory depression. We managed the airways of 10 cases with suspected difficult tracheal intubation under sedation with dexmedetomidine.

A dexmedetomidine loading dose of lmcg x kg(-1) IV was administered over 10 minutes and with supplementation until satisfactory sedation was obtained, followed by infusion of 0.2-0.7mcg x kg(-1) x hr(-1). During loading dose administration, the upper airway was anesthetized topically.

Five cases were intubated fiberscopically, and 3 obstructive sleep apnea syndrome (OSAS) cases received direct laryngoscopy to exclude "cannot intubate, cannot ventilate (CICV)". One case with a large laryngeal tumor had tracheostomy, and another case with recurred pharyngeal cancer was intubated through the permanent tracheotomy site. All the cases were well sedated (Ramsay sedation scale 2-4) and cooperative during the procedure. No respiratory depression nor airway obstruction occurred even in the OSAS cases. In one case hypertension and elevated heart rate were noted transiently during loading dose administration. Another case had postinduction hypotension treated with a small dose of vasopressor. All cases had no uncomfortable recall.

Dexmedetomidine is a safe and effective sedative for awake difficult airway management, for example, fiberscopic intubation, tracheostomy and direct laryngoscopy, though some attention must be paid to circulatory changes.