///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Dexmedetomidine Used to Facilitate Safe Emergence for a Parturient Undergoing Caesarian Section and Thyroidectomy for Airway Obstruction Due to Goiter

Abstract Number: 131
Abstract Type: Case Report/Case Series

C. Christopher Wesley M.D.1 ; H. Jane Huffnagle D.O.2; Suzanne Huffnagle D.O.3

Introduction:

We present a parturient with an obstructing goiter who required urgent thyroidectomy preceded by cesarean section (C/S). Anesthetic management included total intravenous anesthesia (TIVA) following delivery, including dexmedetomidine to facilitate smooth emergence and extubation.

Case Report:

A 38 y/o parturient presented at 36 weeks gestation with a two-week history of exertional dyspnea. Exam revealed a 51", 71 kg female with audible stridor, hoarseness, and a left-sided neck mass. CT showed a 12.5 x 6.5 x 4 cm goiter with tracheal narrowing to 4 mm. Thyroid function studies were normal. She was scheduled for an awake fiberoptic intubation (FOI), C/S, thyroidectomy, tracheostomy, and possible thoracoscopy. We planned to use a bronchial blocker through the tracheostomy for one-lung ventilation.

Two large bore IVs and an arterial line were placed and the airway was anesthetized with 4% lidocaine. Oral FOI was performed using a standard 7.0 endotracheal tube and general anesthesia (GA) was induced with thiopental. Anesthesia was maintained with sevoflurane and N2O in O2. After delivery, we converted to O2/air and TIVA using sufentanil and propofol. The six-hour goiter resection improved airway patency enough to obviate tracheostomy and thoracoscopy, but now required a smooth atraumatic extubation. We switched to a dexmedetomidine infusion to accomplish this.

Prior to extubation the infusion was discontinued. Our patient was breathing spontaneously, following commands and tolerated oral suctioning. She was extubated without coughing, and was closely monitored postoperatively for airway obstruction. She required no additional antiemetics and had adequate analgesia with PCA hydromorphone. Our patient and her infant were discharged on postoperative day four.

Discussion:

Dexmedetomidine is a short-acting α-2 receptor agonist which has central and peripheral activity promoting sedation, analgesia, and sympatholysis(1), without respiratory depression(2). It has been used as a single-agent antiemetic(3) and may reduce nausea and vomiting by decreasing opiate requirements(1,4). As an anti-sialogogue(1) and uterine constrictor(5), it may reduce the occurrence of laryngospasm and uterine atony, and has been used safely for emergence from GA during C/S(6).

Antiemesis, minimizing respiratory depression, extubation without coughing and maintenance of airway reflexes are essential in a patient at high risk for post-extubation tracheal collapse. We believe the addition of dexmedetomidine facilitated this goal and reduced the potential for perioperative complications.

References:

1. Yazbek VG, et al. MEJ Anesth 2006;18;1043-58.

2. Bekker AY, et al. Anesth Analg 2001;92:1251-33.

3. Khasawinah TA, et al. Am J Therapeutics 2004;10:303-7.

4. Shahbaz R, et al. Anesth Analg 2002;95:461-6.

5. Sia AT, et al. Int J Obstet Anesth 2005;14:104-7.

6. Toyama H, et al. Int J Obstet Anesth 2009;18:262-7.

SOAP 2010