Using a thoracic epidural catheter in a high-risk pediatric transplant patient

Although the risks and benefits of regional anesthesia for thoracic surgery are documented, little has been written about using such techniques in pediatric patients undergoing organ transplantation on cardiopulmonary bypass. The placement of thoracic epidurals in unconscious patients, the use of catheters in patients requiring heparinization, and indwelling catheters in immunosuppressed patients are topics of perennial debate. This report describes a thoracic epidural facilitated by intravenous dexmedetomidine in the management of a child who underwent bilateral lung transplantation. Using dexmedetomidine for postoperative sedation may increase the feasibility of regional techniques in patients at increased risk of associated complications.