Sedoanalgesia with dexmedetomidine and ketamine during endoscopic resection of an obstructing tumor of tracheal bifurcation in the patient with lung cancer and its atelectasis

Abstract

The technique of multimodal sedoanalgesia with dexmedetomidine (DMM) and ketamine in combination with lidocaine, which was used in 55 years old male patient for loop electroexcision of a tumor of the right main bronchus, originating from the right lung (adenocarcinoma), which caused atelectasis of this lung and prolapsing into the bifurcation region, is presented. The endotracheal fragment of the tumor periodically blocked the mouth of the left main bronchus, causing attacks of asphyxiation. DMM has the unique ability to cause efficient sedation and moderate analgesia in combination with an antistress effect, and most importantly, without spontaneous breathing depression. In similar situations, these properties of DMM make it an agent of choice for anesthetic management. When working in reflexogenic zones, the addition of small doses of ketamine can increase the effectiveness of the method due to analgesic properties and insignificant effect on respiration. Intravenous administration of lidocaine plus terminal anesthesia with this local anesthetic complements the anesthetic protection.

Keywords

• dexmedetomidine
• ketamine
• endotracheal tumor excision
• obstructive asphyxiation