[Dexmedetomidine infusion for sedation during awake intubation]

Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist that has been used clinically for its analgesic and sedative effects. We report a case of awake intubation with DEX. A 38-year-old male patient with 130 kg in weight, 170 cm in height and with a body mass index of 45 presented with thoracic myelopathy and progressive bladder and bowel control difficulties. Posterior decompression for thoracic myelopathy was planned. He was placed on the operating table with application of routine monitors. DEX infusion was commenced at 5 mcg x kg(-1) x hr(-1) over 10 minutes. Additional DEX at 0.1 mcg x kg(-1) was given 3 times because the patient still felt anxious. During DEX administration, topical anesthesia in the oropharynx, hypopharynx and glottis was achieved using lidocaine 8% spray. The patient was intubated without coughing, movement of limbs or respiratory depression. At the start of laryngoscopy, the patient had a Ramsay sedation score of 6. It was found by pharmacokinetic simulation analysis that the plasma concentration of DEX at intubation was 5.6 ng x ml(-1). We concluded that DEX is a reasonable medication during awake intubation, although further investigations with regard to its safety are required.