Dexmedetomidine Sedation in a Patient With Superior Vena Cava Syndrome and Extreme Needle Phobia

摘要

Superior vena cava syndrome (SVCS) is a life-threatening condition associated with high morbidity and mortality. Providing anesthesia for these patients can be particularly challenging. The induction of general anesthesia may be associated with sudden airway obstruction, hemodynamic compromise, and death. The underlying pathogenesis of cardiorespiratorycompromise in these patients is caused by extrinsic (or intrinsic) airway (with or without cardiac or major vessel) compression. It is particularly concerning that some patients with little or no symptoms of airway compression may develop life-threatening airway obstruction and cardiovascular collapse after the induction of general anesthesia.There are several case reports and review articles on the methods of providing anesthesia for these patients. Suggested options include local anesthesia in patients with evidence of severe airway obstruction, general anesthesia with spontaneous ventilation, and elective preparation for venovenous bypass, which involves cannulating the femoral vessels and priming a cardiopulmonary bypass circuit before the induction of general anesthesia. A thorough review of the medical literature did not reveal any previous report of the use of dexmedetomidine for sedation and analgesia in these patients.Therefore, the management of a patient with a large anterior mediastinal mass associated with clinical and radiologic features of SVCS is presented using a dexmedetomidine infusion for sedation and analgesia during anterior mediastinotomy (Chamberlain's procedure). This minimally invasive procedure involves a left parasternal incision and deep dissection to gain access to the lymph nodes in the aortopulmonary window.