Awake intubation under sedation using target-controlled infusion of dexmedetomidine: five case reports

Abstract

We used target-controlled infusion (TCI) of dexmedetomidine (DEX) for awake intubation under sedation in 5 patients who had a risk of pulmonary aspiration or difficult airway. Dexmedetomidine level was escalated stepwise until the patients developed tolerance to laryngoscopy. The target DEX concentrations at the time of intubation were 2.10–5.95 ng/ml and were higher than those clinically used for sedation in the intensive care unit (ICU). Chin lift was applied in 1 case, and therefore no assisted ventilation was required and pulse oxygen saturation was maintained at >98% throughout the procedure. Simple pharmacological interventions for blood pressure changes induced by increased target plasma DEX concentrations were needed in 4 cases. However, hemodynamics was stable, and no cardiovascular drug was needed after tracheal intubation. Conditions at laryngoscopy were excellent in all cases, and conditions at tracheal intubation were good except in 1 case. Reflex to intubation was preserved in all cases, and coughing was observed in all cases. The patients had no memory of discomfort and/or intubation. Although further investigations are needed, this method may be useful for awake intubation under sedation.