Tracheotomy In Which Dexmedetomidine Alone Was Safely Used In A High-Risk Elderly Patient

Abstract

We experienced a case in which dexmedetomidine (DEX) was useful in sedation for tracheotomy in a high-risk elderly patient. Use of DEX for sedation during an invasive procedure was approved and monitored by the Research Ethics Committee of Asahikawa Medical College, and informed consent was obtained from the patient’s family. The patient was a 90-year-old male with a weight of 44 kg and height of 151 cm. He had undergone emergency craniotomy for sudden-onset intracranial hematoma one week before. He had been intubated due to continuing consciousness disorder and was scheduled for tracheotomy. He had left hemiplegia and only showed response to painful stimuli and he never opened his eyes or made sounds. Neurosurgeons asked us to perform perioperative management to avoid movement of the patient’s body and also requested spontaneous breathing to be preserved for the following reason: Since a large vein located in his neck where the tracheal cannula would enter the trachea may prevent replacement of the tracheal tube with the tracheal cannula, preserving spontaneous breathing was thought to be preferable in order to gain time until desaturation. We selected DEX for sedation for the tracheotomy since DEX has little effect on the respiratory system.