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Pediatric cardiac catheterization procedure with dexmedetomidine sedation: radiographic airway patency assessment
Ashwini Thimmarayappa, Nivash Chandrasekaran1, A M Jagadeesh
1Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Insights
Dexmedetomidine sedation in children undergoing cardiac catheterization reduced upper airway dimensions, indicating potential collapsibility. Airway patency was maintained, but vigilance for airway failure is crucial during this pediatric sedation.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Radiology
Background:
- Dexmedetomidine is commonly used for procedural sedation in children.
- Assessing airway patency during sedation is critical for patient safety.
- Pediatric cardiac catheterization requires careful sedation management.
Purpose of the Study:
- To objectively measure upper airway patency during dexmedetomidine sedation in pediatric patients.
- To evaluate radiographic changes in airway dimensions under sedation.
- To assess the impact of dexmedetomidine on airway collapsibility in children.
Main Methods:
- Thirty-five pediatric patients (5-10 years) undergoing cardiac catheterization received dexmedetomidine.
- Radiographic antero-posterior (AP) diameters of the nasopharynx and retroglossal regions were measured.
- Airway collapsibility was assessed by dynamic changes between inspiration and expiration.
Main Results:
- Significant reductions in nasopharyngeal and retroglossal AP diameters were observed post-sedation.
- Increased airway collapsibility was noted at 30 minutes compared to baseline.
- Heart rate decreased significantly, with an average recovery time of approximately 40 minutes.
Conclusions:
- Dexmedetomidine sedation maintained airway patency in pediatric patients but reduced upper airway dimensions.
- Radiographic assessment revealed significant narrowing of the upper airway.
- Precautions for managing potential airway failure are recommended during dexmedetomidine sedation.
Aims:
The aim of the study was to measure airway patency objectively during dexmedetomidine sedation under radiographic guidance in spontaneously breathing pediatric patients scheduled for cardiac catheterization procedures.
Subjects And Methods:
Thirty-five patients in the age group 5-10 years scheduled for cardiac catheterization procedures were enrolled. All study patients were given loading dose of dexmedetomidine at 1 mg/kg/min for 10 min and then maintenance dose of 1.5 mg/kg/h. Radiographic airway patency was assessed at the start of infusion (0 min) and after 30 min. Antero-posterior (AP) diameters were measured manually at the nasopharyngeal and retroglossal levels. Dynamic change in airway between inspiration and expiration was considered a measure of airway collapsibility. Patients were monitored for hemodynamics, recovery time and complications.
Statistical Analysis:
Student paired t-test was used for data analysis. P < 0.05 was considered significant.
Results:
Minimum and maximum AP diameters were compared at 0 and 30 min. Nasopharyngeal level showed significant reduction in the minimum (6.27 ± 1.09 vs. 4.26 ± 1.03, P < 0.0001) and maximum (6.51 ± 1.14 vs. 5.99 ± 1.03, P < 0.0001) diameters. Similarly retroglossal level showed significant reduction in the minimum (6.98 ± 1.09 vs. 5.27 ± 1.15, P < 0.0001) and maximum (7.49 ± 1.22 vs. 6.92 ± 1.12, P < 0.0003) diameters. The degree of collapsibility was greater at 30 min than baseline ( P < 0.0001). There was a significant decrease in heart rate ( P < 0.0001), and the average recovery time was 39.86 ± 12.22 min.
Conclusion:
Even though airway patency was maintained in all children sedated with dexmedetomidine, there were significant reductions in the upper airway dimensions measured, so all precautions to manage the airway failure should be taken.
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