Dexmedetomidine as an anaesthetic adjunct for management of difficult airway in a patient with facial injury following bear maul
Keywords:
airway management, dexmedetomidine, facial injuryAbstract
The management of difficult airway is one of the most challenging tasks for the anaesthesiologist. Life threatening cannot intubate and cannot ventilate situation can be avoided by performing awake-fibreoptic intubation. Although there are many techniques described for fibreoptic intubation but relative merits and demerits of each technique should be considered. The key to successful awake-fibreoptic intubation depends upon the meticulous preparation of the patient and the equipments. Many methods of sedation have been described but theirs side effects are the limitations. Dexmedetomidine, a selective alpha2 adrenergic agonist, has unique property of conscious sedation. Besides, dexmedetomidine has additional property of analgesia, reflex blunting and anti-sialogogue, which can further improve the success rate of awake-fibreoptic intubation in cases with difficult airway. We described a case of bear maul of face with anticipated difficult airway successfully conducted awake-fibreoptic intubation with the use of dexmedetomidine.
References
2. Walsh ME, Shorten GD. Preparing to perform an awake-fibreoptic intubation. Yale journal of biology and medicine 1998;78:537-49.
3. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent) 2001;14:13-21.
4. Belleville JP, Ward DS, Bloor BC. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation and metabolic rate. Anesthesiology 1992;77:1125-33.
5. Abdelmalak B, Makary L, Hoban J, Doyle DJ. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. J Clin Anesth 2007;19:370-3.
6. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia 1997;52:736-44.
7. Chu KS, Wang FY, Hsu HT, Lu IC, Wang HM, Tsai CJ. The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake-fibreoptic nasal intubation. Eur J Anaesthesiol 2010;27:36-40.
8. Watanabe H, Lindren L, Rosenberg P, Randell T. Glycopyrronium prolongs topical anaesthesia of the oral mucosal and enhances absorption of lignocaine. BJA 1993;70:94-5.
9. Maroof M, Khan R, Jain D. Dexmedetomidine is a useful adjunct for awake intubation. Can J Anesth 2005;52:776-7.
10. Johnston KD, Rai MR. Conscious sedation for awakefibreoptic intubation: a review of the literature. Can J Anaesth 2013;60:584-99.
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