Dexmedetomidine for Awake Intubation Procedure in Subtotal Thyroidectomy

Riandini Pramudita Riyanti, Paramita Putri Hapsari

Abstract


Background: Giant struma makes airway management difficult for the anesthesiologist due to the risk of tracheal intubation failure. Awake fiberoptic intubation(AFOI) is the gold standard in the management of a predicted difficult airway. Giving analgesia and sedation can facilitate operator and patient comfort during the awake intubation procedure.

Case: We report the case of a 63-year-old woman with a giant struma who was planned for a subtotal thyroidectomy. We provide ondansetron and dexamethasone premedication, analgesia and sedation using dexmedetomidine, propofol induction, muscle relaxant atracurium, with maintenance anesthetic sevoflurane. Dexmedetomidine was administered on loading dose 0.8 µg /kg/hour in the first 10 minutes then continue on analgesia dose 0.2 µg /kg. During the AFOI procedure, 100% oxygenation was given with the patient's hemodynamic range, namely systolic blood pressure of 110-131 mmHg, diastolic blood pressure of 75-93 mmHg, heart rate of 77-91 beats per minute, and SpO2 of 98-100%. Postoperatively the patient was transferred to the Intensive care unit (ICU) with an endotracheal tube intube. Monitoring of postoperative complications such as production of thyroid crisis drainage and extubation 24 hours after surgery was confirmed by the cuff leak test.

Conclusion: Giving dexmedetomidine is better than opioids in the AFOI procedure because of its minimal respiratory depressant effect. Maintaining hemodynamic stability during the AFOI procedure is very important to avoid hemodynamic fluctuations so it can minimize the risk of perioperative complications.


Keywords


giant struma; airway management; AFOI; dexmedetomidine; thyroidectomy

References


Kaur H, Kataria A, Muthuramalingapandian M, Kaur H. Airway considerations in case of a large multinodular goiter. Anesth Essays Res. 2017;11(4):1097.

Raval C, Rahman S. Difficult airway challenges-intubation and extubation matters in a case of large goiter with retrosternal extension. Anesth Essays Res. 2015;9(2):247.

Hegedüs L, Bonnema SJ. Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter. The Journal of Clinical Endocrinology & Metabolism. 2010 Dec;95(12):5155–62.

Bartolek D, Frick A. Huge multinodular goiter with mid trachea obstruction: indication for fiberoptic intubation. Acta Clin Croat. 2012 Sep;51(3):493–8.

Dempsey GA, Snell JA, Coathup R, Jones TM. Anaesthesia for massive retrosternal thyroidectomy in a tertiary referral centre. British Journal of Anaesthesia. 2013 Oct;111(4):594–9.

Gaszynski T, Gaszynska E, Szewczyk T. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation. DDDT. 2014 Jul;909.

Chopra P, Dixit M, Dang A, Gupta V. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients. J Anaesthesiol Clin Pharmacol. 2016;32(1):54.

Yazbek-Karam VG, Aouad MM. Perioperative uses of dexmedetomidine. Middle East J Anaesthesiol. 2006 Oct;18(6):1043–58.

Ramsay MAE, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology. 2004 Sep;101(3):787–90.




DOI: http://dx.doi.org/10.21776/ub.jap.2022.003.02.04

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.