Dr. Saenz is a staff anesthesiologist and Dr. Guruli is chief of Anesthesiology Service, both at G.V. (Sonny) Montgomery VAMC in Jackson, Mississippi. Dr. Saenz and Dr. Guruli also are both assistant professors of anesthesiology at the University of Mississippi Medical Center in Jackson.
Although the pathology report was benign for this patient, it was thought that prior to the surgery a reduction in opioid usage was important because he may have had a thyroid carcinoma in addition to the other respiratory considerations. Additionally, it was desired to decrease the amount of volatile anesthetic agents needed for this patient, because the surgical procedure was anticipated to be quite prolonged (it lasted 15 hours).
Conclusions
Recent research showed that a dexmedetomidine infusion combined with a low-dosage midazolam was superior to a higher dosage midazolam regimen for awake fiberoptic intubation in terms of stability, comfort, cooperation, and patient satisfaction.11 This is an example of the utility of dexmedetomidine. It is often insufficient when used alone, but as an adjunct will markedly reduce the dosage of other sedatives needed to achieve the desired Ramsey sedation scores and/or clinical benefit. Additionally, dexmedetomidine has been shown to facilitate weaning patients in a case series (who had previously failed weaning) from mechanical ventilation in surgical intensive care settings.12
The use of dexmedetomidine facilitated awake intubation for this patient and was helpful for postoperative sedation. The authors believe that dexmedetomidine has potential benefits in all phases of surgery and is a potentially valuable addition to the anesthesiologist’s and intensivist’s armamentarium.
Acknowledgements This work was conducted at and supported by the G.V. (Sonny) Montgomery VA Medical Center in Jackson, Mississippi.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
