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Dexmedetomidine and Awake Fiberoptic Intubation for Possible Cervical Spine Myelopathy: A Clinical Series

Avitsian, Rafi MD; Lin, Jia MD, PhD; Lotto, Michelle MD; Ebrahim, Zeyd MD

Journal of Neurosurgical Anesthesiology: April 2005 - Volume 17 - Issue 2 - p 97-99
doi: 10.1097/01.ana.0000161268.01279.ba
Clinical Report
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For many anesthesiologists, awake fiberoptic endotracheal intubation (AFOBI) is the preferred method of intubation when treating patients with symptoms or signs of cervical spinal cord compression. The advantage of this method is to minimize cervical spine movements that could contribute to neurologic impairment. In patients who are anxious or poorly cooperative, adequate sedation in addition to topicalization of the airway may be key to minimize patient discomfort and assist in successful intubation, but imposes the risk of respiratory depression. Dexmedetomidine has the advantage of producing sedation without a significant decrease in respiratory drive. We are now reporting our experience of a series of AFOBI using dexmedetomidine for sedation. A retrospective chart review was conducted on the anesthetic records of patients, who had undergone an awake fiberoptic endotracheal intubation (AFOBI) using dexmedetomidine for sedation. These were patients in whom AFOBI was indicated because of signs or symptoms of cervical spinal cord compression. Dexmedetomidine provided adequate sedation. We did not encounter any loss of airway or airway obstruction during the intubation. The patients had excellent cooperation for post-intubation neurologic examination. Thirteen patients developed transient hypotension after induction of general anesthesia that was managed with boluses of phenylephrine or ephedrine.

From the Division of Anaesthesiology and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication December 17, 2004; accepted February 11, 2005.

There has been no funding source from any commercial or non-commercial affiliations to support this clinical study.

Implication Statement: Dexmedetomidine can be used to sedate patients to improve acceptance of awake fiberoptic intubation.

Reprints: Rafi Avitsian, MD, Cleveland Clinic Foundation, Department of General Anesthesiology E31, 9500 Euclid Ave., Cleveland, OH 44195 (e-mail: avitsir@ccf.org).

© 2005 Lippincott Williams & Wilkins, Inc.