Dexmedetomidine sedation for laryngeal framework surgery.
OBJECTIVE
Sedation for laryngeal framework surgery has lacked easy modulation between appropriate pain control, airway protection, and the alertness appropriate for vocal testing. Our objective was to determine whether dexmedetomidine hydrochloride could safely and effectively be used as the sole intravenous anesthetic agent in conjunction with local anesthesia for laryngeal framework procedures.


METHODS
We undertook a prospective review of 14 patients who underwent laryngeal framework surgery with dexmedetomidine anesthesia in 2004 and 2005. All dexmedetomidine doses, sedation levels, and vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation level, were recorded every 15 minutes by the anesthesiologist throughout the duration of the procedures. Operative conditions were noted by the surgeon, focusing special attention on airway protection, patient arousability, and patient comfort.


RESULTS
Dexmedetomidine sedation produced hemodynamic and respiratory values that were maintained near preoperative values, and overall pharyngeal-laryngeal integrity provided superior operating conditions for the patient and the operating surgeon.


CONCLUSIONS
We believe that dexmedetomidine provides excellent sedative and operative conditions for awake laryngeal framework procedures. Coupled with local anesthesia, dexmedetomidine produced virtually no undesirable hemodynamic or respiratory effects, while allowing for adequate sedation the majority of the time. The operative conditions were markedly improved over those of previous standard monitored anesthesia regimens.
Department of Anesthesiology, University of Washington, Seattle, Washington, USA.
Ryan J
RJ
Jense
Karen
K
Souter
Jo
J
Davies
Christopher
C
Romig
Ashok
A
Panneerselvam
Nicole
N
Maronian
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D016292:Procedural Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine