Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Case Report

Near ideal anesthetic technique for tracheal stenting in central airway obstruction with dexmedetomidine-ketamine infusion: a case report

Sakshi Thakore, Nishkarsh Gupta, Karan Madan, Sushma Bhatnagar

Downloads: 0
Views: 9


Central airway obstruction presents as an emergency with dyspnea and stridor. Anesthetic management of rigid bronchoscopy-guided tracheal stenting is highly stimulating procedure requiring general anesthesia. But it may lead to life threatening airway obstruction and cardiovascular collapse after induction. Total intravenous anesthesia based on propofol-remifentanil is an optimal anesthetic technique, but remifentanil is not available in many countries. Although dexmedetomidine-ketamine has been used for procedural sedation, its use for rigid bronchoscopy in the setting of central airway obstruction has not been described in literature. We describe near ideal anesthetic technique for management of central airway obstruction using dexmedetomidine-ketamine combination.


Ketamine,  Dexmedetomidine,  Central airway obstruction,  Rigid bronchoscopy,  Case report


1 M. Bakan, U. Topuz, T. Umutoglu, et al. Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine Clinics, 69 (6) (2014), pp. 372-377

2 S. Morita, N. Akasaka, M. Sakamoto, T. Tateda Anesthetic management with remifentanil for tracheobronchial stent insertion Masui, 59 (2010), pp. 183-187

3 N. Prakash, T. McLeod, F. Gao Smith The effects of remifentanil on haemodynamic stability during rigid bronchoscopy Anaesthesia, 56 (June (6)) (2001), pp. 576-580

4 J.D. Tobias Dexmedetomidine and ketamine: an effective alternative for procedural sedation? Pediatr Crit Care Med, 13 (2012), p. 423

5 W.H. Ban, J.M. Lee, J.H. Ha, et al. Dyspnea as a prognostic factor in patients with non-small cell lung cancer Yonsei Med J, 57 (2016), pp. 1063-1069

6 A.B. Munari, A.A. Gulart, K. dos Santos, R.S. Venâncio, M. Karloh, A.F. Mayer Modified medical research council dyspnea scale in gold classification better reflects physical activities of daily living Respiratory Care, 63 (2018), pp. 77-85

7 L. Freitag, A. Ernst, M. Unger, K. Kovitz, C.H. Marquette A proposed classification system of central airway stenosis Eur Respir J, 30 (2007), pp. 7-12

8 I.D. Conacher Anaesthesia and tracheobronchial stenting for central airway obstruction in adults BJA Br J Anaesth, 90 (2003), pp. 367-374

9 S. Naaz, E. Ozair Dexmedetomidine in current anaesthesia practice—a review J Clin Diagn Res JCDR, 8 (2014) GE01–4

10 M. Kaur, P.M. Singh Current role of dexmedetomidine in clinical anesthesia and intensive care Anesth Essays Res, 5 (2011), pp. 128-133

11 J.L. Seybold, R.J. Ramamurthi, G.B. Hammer The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction Pediatr Anesth, 17 (2007), pp. 1212-1214

12 V.S. Joshi, S.S. Kollu, R.M. Sharma Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory Ann Card Anaesth, 20 (2017), pp. 422-426

13 A. Jaikaria, S. Thakur, P. Singhal, D. Chauhan, C. Jayam, K. Syal A comparison of oral midazolam-ketamine, dexmedetomidine-fentanyl, and dexmedetomidine-ketamine combinations as sedative agents in pediatric dentistry: a triple-blinded randomized-controlled trial Contemp Clin Dent, 9 (2018), pp. S197-S203

14 R. Goyal, S. Singh, A. Bangi, S.K. Singh Case series: dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery J Anaesthesiol Clin Pharmacol, 29 (2013), pp. 543-546

15 C.S. Scher, M.C. Gitlin Dexmedetomidine and low-dose ketamine provide adequate sedation for awake fibreoptic intubation Can J Anaesth, 50 (2003), pp. 607-610

16 S.K. Sinha, B. Joshiraj, L. Chaudhary, N. Hayaran, M. Kaur, A. Jain A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fiberoptic nasotracheal intubation: a randomized controlled study J Anaesthesiol Clin Pharmacol, 30 (2014), p. 514

17 O. Hung, D. McKeen, J. Huitink Our love-hate relationship with succinylcholine: is sugammadex any better? Succinylcholine, nous t’aimons, nous te haïssons: et toi, suggammadex, es-tu mieux loti? Can J Anaesth, 63 (2016), pp. 905-910

60982fc5a953956c83060066 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections