The use of “High Dose” Dexmedetomidine in a Patient with Critical Tracheal Stenosis and Anterior Mediastinal Mass

C Voscopoulos,M Lema,F.L Kirk,M Lovrincevic

doi:10.2174/1874321801105010042

C Voscopoulos, M Lema + Show 2 more

Open Access

https://doi.org/10.2174/1874321801105010042

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Abstract

The anterior medial mass patient continues to offer great challenges for the anesthesiologist. As such, newer and safer methods of providing anesthetic care are continually being sought. To this end, there is a growing body of evidence that may suggest that higher than Food and Drug Administration approved dosages of dexmedetomidine may offer another option in the arsenal of the anesthesiologist in this patient population. We recently cared for a middle aged male who presented with a large mediastinal mass, extrinsic compression critical tracheal stenosis, superior vena cava syndrome, and massive supraclavicular lymphadenopathy, scheduled for tracheal stent placement, biopsy, and diagnostic evaluation of the esophagus. After reviewing anesthetic options, we deemed the safest technique available to us to be the use of a high dose dexmedetomidine based technique with continuous infusion rate of 2mcg/kg/hr. Spontaneous respirations were maintained throughout the case, with a stable heart rate and blood pressure, and our patient tolerated the procedure without complications.

Highlights

General anesthesia in patients with an anterior mediastinal mass has been associated with hemodynamic and airway collapse
Upon presentation of a middle aged male with a large mediastinal mass, extrinsic compression critical tracheal stenosis, superior vena cava syndrome, and massive supraclavicular lymphadenopathy, scheduled for tracheal stent placement and diagnostic evaluation of the esophagus, we determined that the use of a higher than current Food and Drug Adminisration (FDA) approved dose dexmedetomidine based technique was the best option for our patient
In 1999, the US FDA approved the use of dexmedetomidine for two indications and usages; sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting, continuous infusion not to exceed 24 hours, and, sedation of non-intubated patients prior to and/or during surgical and other procedures

Summary

INTRODUCTION

General anesthesia in patients with an anterior mediastinal mass has been associated with hemodynamic and airway collapse. Upon presentation of a middle aged male with a large mediastinal mass, extrinsic compression critical tracheal stenosis, superior vena cava syndrome, and massive supraclavicular lymphadenopathy, scheduled for tracheal stent placement and diagnostic evaluation of the esophagus, we determined that the use of a higher than current Food and Drug Adminisration (FDA) approved dose dexmedetomidine based technique was the best option for our patient. This technique has been described best in the pediatric population, with only a few published adult reports. EGD and biopsy followed, again with the patient being able to fully tolerate these procedures without the need for increased anesthetic requirements

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CONCLUSIONS