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Title
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Efficacy and safety of spontaneous ventilation using dexmede-tomidine-remifentanil in children undergoing direct laryngoscopy for surgical procedures : a single cohort observational study
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Author
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Abstract
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| Introduction : Supraglottoplasty is a procedure performed in the management of laryngomalacia. Using direct laryngoscopy, redundant supraglottic tissue is resected. Spontaneous ventilation is preferred to allow both adequate oxygenation and a clear surgical working space. Because of its ability to maintain respiratory drive and airway patency, dexmedetomidine is increasingly used during endoscopic airway procedures. However, literature regarding its use for direct laryngoscopy with surgical intervention is limited. Research goals : Evaluation of the efficacy and safety of spontaneous ventilation using dexmedetomidine-remifentanil in children undergoing direct laryngoscopy with surgical intervention. Methods : In this single cohort observational study, children undergoing supraglottoplasty were recruited. After inhalational induction, IV access was gained. Rapid bolus dosing of dexmedetomidine 4 mu g kg(-1) was followed by dexmedetomidine at 2 mu g kg(-1) and remifentanil at 0.3 mu g kg(-1) min(-1) as maintenance. During surgery, spontaneous ventilation was maintained. Results : 26 children were enrolled. Adverse airway events were frequent : laryngospasm in 12/26 (46%), apnea in 10/26 (38%). However, only 5/26 (19%) resulted in desaturation. Hemodynamic adverse events were : bradycanlia 12/25 (48 degrees/0), tachycardia 2/24 (8%), hypertension 6/15 (40%) and hypotension 2/15 (13%). Missing hemodynamic baseline data in some subjects precluded analysis. Body movement occurred in 3/26 (12%), cough in 2/26 (8%). Total procedure time lasted 53 (SD 18) min consisting of 9 (SD 3) min induction time, 29 (SD 12) min surgical time and 16 (SD 8) min wake up time. Surgery was successful in all cases with high surgery satisfaction scores. Conclusion : The combination of dexmedetomidine-remifentanil can be a safe and efficacious method to allow spontaneous ventilation in children undergoing direct laryngoscopy with surgical intervention. Although laryngospasm and apnea were frequent, serious consequences such as desaturation were rare. Rapid bolus dosing of dexmedetomidine was hemodynamically well tolerated and allowed short induction times with good surgical conditions. |
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Language
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English
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Source (journal)
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Acta anaesthesiologica belgica / Belgische Vereniging voor Anesthesie en Reanimatie; Society for Anesthesia and Resuscitation of Belgium. - Brussel, 1950, currens
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Publication
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Brussel
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2020
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ISSN
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0001-5164
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Volume/pages
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71
:s:[1]
(2020)
, p. 87-92
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ISI
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000641759600012
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