Asunto(s)
Mutación de Línea Germinal/genética , Osteosarcoma/genética , Proteína 2 del Complejo de la Esclerosis Tuberosa/genética , Esclerosis Tuberosa/genética , Proteína p53 Supresora de Tumor/genética , Angiofibroma/complicaciones , Angiomiolipoma/complicaciones , Astrocitoma/complicaciones , Niño , Femenino , Humanos , Mutación Missense/genética , Osteosarcoma/tratamiento farmacológicoRESUMEN
We treated 2 patients, 1 undergoing placement and 1 removal of a tracheobronchial Dumon stent, both of whom required preservation of spontaneous breathing during the perioperative period to avoid life-threatening hypoxemia, with dexmedetomidine (DEX) as an anesthetic adjunct. In both cases, anesthesia was induced with 6 microg x kg(-1) x hr(-1) of DEX for 10 minutes and then maintained at 0.4-0.8 microg x kg(-1) x hr(-1), along with a target controlled infusion of propofol combined with intermittent administrations of low-dose fentanyl. Muscle relaxants were avoided and spontaneous breathing was preserved throughout the surgical procedures. The airway was secured using a rigid bronchoscope specific for a Dumon stent procedure. No rescue device, such as high frequency jet ventilation or a percutaneous cardiopulmonary support system, was needed. The perioperative courses were uneventful without any pulmonary or cardiovascular complications. DEX has potent sedative, amnesic, and analgesic properties with a low respiratory depressant effect. Therefore, it is considered useful as a concomitant anesthetic agent for perioperative management of patients who require preservation of spontaneous breathing.
