Dexmedetomidine Sedation After Tracheal Surgery. A Prospective Pilot Study

Background: Fourteen adults undergoing tracheal resection and reconstruction surgery were enrolled in this prospective observational pilot study to evaluate dexmedetomidine-based sedation after tracheal surgery in an Intensive Care Unit. Patients remain electively intubated with an uncuffed nasal endotracheal tube, awake and exhibit spontaneous breathing. The neck was maintained in flexion through chin- to-chest sutures. Infusion of dexmedetomidine was started from a dosage of 0.7 μg kg- 1 h-1 followed by dose titration to the target level of the sedation Richmond Agitation Sedation Scale, (RASS) score –1/–2 using a dose range of 0.2–1.4 μg kg-1 h-1. Results: The mean sedation levels were within the target ranges during the entire 18- hours observation period with a significant decrease in RASS (baseline RASS 1.43 0.5118h RASS -0.860.95, p<0.005). The mean arterial pressure (MAP) and heart rate (HR) were significantly decreased during dexmedetomidine infusion (baseline MAP 90.2914.33 mmHg vs. 18h MAP 82.50 15.44 mmHg; baseline HR 81.5012.76 bpm vs. 18h HR 69.2910.21 bpm, p<0.005). The visual analog scale (VAS) scores significantly decreased (baseline VAS 4.14 0.86 vs. 18 h VAS 2.790.67, p<0.005). Peripheral oxygen saturation did not exhibit any significant decrease. Bradycardia occurred in one patient who assumed beta-blocker therapy without significant changes in blood pressure and was resolved by titration of the infusion without suspending sedation. No cases of delirium were encountered, and no additional sedative or analgesic was required. Conclusion: Dexmedetomidine provided safe and effective sedation after tracheal surgery in spontaneous breathing patients without causing respiratory depression.