title: Awake intubation under sedation using target-controlled infusion of dexmedetomidine: five case reports.
abstract: We used target-controlled infusion (TCI) of dexmedetomidine (DEX) for awake intubation under sedation in 5 patients who had a risk of pulmonary aspiration or difficult airway. Dexmedetomidine level was escalated stepwise until the patients developed tolerance to laryngoscopy. The target DEX concentrations at the time of intubation were 2.10-5.95 ng/ml and were higher than those clinically used for sedation in the intensive care unit (ICU). Chin lift was applied in 1 case, and therefore no assisted ventilation was required and pulse oxygen saturation was maintained at >98% throughout the procedure. Simple pharmacological interventions for blood pressure changes induced by increased target plasma DEX concentrations were needed in 4 cases. However, hemodynamics was stable, and no cardiovascular drug was needed after tracheal intubation. Conditions at laryngoscopy were excellent in all cases, and conditions at tracheal intubation were good except in 1 case. Reflex to intubation was preserved in all cases, and coughing was observed in all cases. The patients had no memory of discomfort and/or intubation. Although further investigations are needed, this method may be useful for awake intubation under sedation.
authors.affiliation: Surgical Operation Department, Asahikawa Medical College Hospital, Asahikawa, Japan. taka.kunisawa@nifty.ne.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kunisawa
authors.forename: Michio
authors.initials: M
authors.lastname: Nagashima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hanada
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D003371:Cough / Q000503:physiopathology; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000097:blood; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine