Awake thyroidectomy under local anesthesia and dexmedetomidine infusion.
Dexmedetomidine (DEX) is an alpha-2 receptor agonist with sedative and analgesic properties. It has been reported to preserve the patient's ability to cooperate and provide opioid sparing properties. Patients with obstructive sleep apnea (OSA) have demonstrated an increased risk for oxygen desaturation following general anesthesia. We report a case of a 64-year-old male, ASA IV with severe chronic obstructive pulmonary disease, OSA, unilateral vocal cord dysfunction, gastro-esophageal reflux disease, and congestive heart failure undergoing an awake thyroidectomy under local anesthesia and a DEX infusion. The patient was given a loading dose of DEX of 1 mcg/kg and an infusion ranging from 0.2 to 1.0 g/kg/hr. He received a total of 250 mcg of fentanyl and 7.5 mg of ketorolac throughout the case.


RESULTS
The patient tolerated the procedure well. He was able to cooperate with simple commands. His vital signs remained stable. He reported a pain score of 2 out of 10 in the recovery unit.


CONCLUSIONS
This case demonstrates the successful use of a DEX infusion along with local anesthesia administered by the surgeon for an awake thyroidectomy.
Plunkett
Anthony R
AR
Walter Reed Army Medical Center, 6900 Georgia Avenue, NW Washington, DC 20307, USA.
Shields
Cynthia
C
Stojadinovic
Alex
A
Buckenmaier
Chester C
CC
D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000772:Anesthesia, Local; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013965:Thyroidectomy
D018712:Analgesics, Non-Narcotic; D020927:Dexmedetomidine