Efficacy of dexmedetomidine for awake bronchoscopy in a 3-month infant with severe subglottic stenosis and pneumothorax due to cervical cystic lymphangioma

A 3-month-old female infant was admitted because of tachypnea and retractive breathing. Chest X-ray and computed tomography demonstrated right pneumothorax and severe subglottic stenosis. She was scheduled for chest drainage and diagnostic fiberoptic bronchoscopy (FOB), and securing airway by tracheal intubation or tracheostomy. Continuous infusion of dexmedetomidine(DEX, 125 μg • kg^-1 • hr^-1) was started and it was increased to 3.75 μg • kg^-1 • hr^-1 ten minutes later. Chest drainage was performed with regional anesthesia under deep sedation and she responded only to painful stimulus. After the completion of the chest drainage, chest X-ray revealed the expansion of her right lung. Then, FOB was performed under regional anesthesia with DEX sedation. Moderate sub-glottic stenosis under spontaneous breathing, and the disappearance of the stenosis under positive pressure ventilation was observed by FOB. FOB findings suggested that she had acquired tracheomalacia due to external compression by cervical cystic lymphangioma Therefore, to avoid deterioration of her tracheomalacia we did not perform tracheal intubation or tracheostomy, which could provoke tracheal edema deformation and subsequent further deterioration of airway stenosis. Although the dose of DEX was higher than the recommended dose, high dose DEX led to adequate sedation and analgesia for pediatric FOB without respiratory distress or hemodynamic instability. We believe that DEX is useful for an infant with difficult airway requiring preservation of airway smooth muscle tone and spontaneous breathing.