Editorial - The use of “High Dose” Dexmedetomidine in a Patient with Critical Tracheal Stenosis andAnterior Mediastinal Mass

摘要

Patients who present with an anterior mediastinal mass requiring surgical intervention continue to be a challenge for anesthetic care. The risk for airway and hemodynamic collapse during general anesthesia with inhaled agents complicates the management of these patients. Anesthetics that maintain spontaneous ventilation are optimal in this setting. Dexmedetomidine, a selective alpha2 agonist, which is devoid of significant respiratory depression at clinically approved doses, may have a role. However, there is a paucity of data quantifying level of anesthesia, as well as respiratory and hemodynamic response with high dose dexmedetomidine in adult patients. Previous case reports demonstrate a wide range of doses necessary to provide anesthesia [1-3]. Voscopoulos et al., described a case involving an adult patient with critical tracheal stenosis and a large mediastinal mass undergoing a tracheal stent placement and diagnostic evaluation of the esophagus. They utilized a high dose dexmedetomidine infusion to facilitate the procedure (1 mcg/kg/hr for 10 minutes followed by 2 mcg/kg/hr for 60 minutes).