Anesthesia for tracheostomy for huge maxillofacial tumor

Area of Science:

• Anesthesiology
• Oncology
• Surgical Procedures

Background:

• Managing sedation in patients with compromised upper airways presents significant clinical challenges.
• Maxillofacial tumors can obstruct the airway, necessitating advanced airway management strategies.
• Difficult venous access complicates standard anesthetic and sedation protocols.

Observation:

• A 19-year-old female patient with a large maxillofacial tumor obstructing the pharynx required tracheostomy.
• The patient had a gastrostomy tube for nutrition and refused venous cannulation due to difficult veins.
• Preoperative sedation was administered via the gastrostomy tube using dexmedetomidine and ketamine.

Findings:

• Oral administration of dexmedetomidine and ketamine provided adequate sedation, allowing patient cooperation with commands.
• Application of eutectic mixture of local anesthetics cream and local infiltration ensured effective local anesthesia.
• The tracheostomy procedure was successfully completed under local anesthesia without patient distress or recall.

Implications:

• Oral dexmedetomidine-ketamine sedation offers a viable alternative for patients with compromised airways and difficult venous access.
• This approach can facilitate elective procedures like tracheostomy in challenging oncological cases.
• Gastrostomy tube administration of sedatives bypasses the need for venous access, improving patient safety and comfort.