Saito Kazutomo, Toyama Hiroaki, Ejima Yutaka, Haitani Azusa, Yamauchi Masanori
Masui. 2016 Oct;65(10):1026-1030.
A 3-month-old female infant was admitted because of tachypnea and retractive breathing. Chest X-ray and computed tomography demonstrated right pneumo- thorax and severe subglottic stenosis. She was sched- uled for chest drainage and diagnostic fiberoptic bron- choscopy (FOB), and securing airway by tracheal intubation or tracheostomy. Continuous infusion of dexmedetomidine(DEX, 1.25 iμ · kg(-1) · hr(-1))was started and it was increased to 3.75,μg · kg(-1) · hr(-1) ten min- utes 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 sug- gested 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 tracheos- tomy, which could provoke tracheal edema, deforma- tion and subsequent further deterioration of airway stenosis. Although the dose of DEX was higher than the rec- ommended dose, high dose DEX led to adequate seda- tion and analgesia for pediatric FOB without respira- tory 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.
一名3个月大的女婴因呼吸急促和吸气性呼吸困难入院。胸部X线和计算机断层扫描显示右侧气胸和严重的声门下狭窄。她计划接受胸腔引流和诊断性纤维支气管镜检查（FOB），并通过气管插管或气管切开术确保气道安全。开始持续输注右美托咪定（DEX，1.25μg·kg⁻¹·hr⁻¹），10分钟后增加至3.75μg·kg⁻¹·hr⁻¹。在深度镇静下进行区域麻醉后进行胸腔引流，她仅对疼痛刺激有反应。胸腔引流完成后，胸部X线显示右肺扩张。然后，在DEX镇静下进行区域麻醉下的FOB。FOB观察到自主呼吸时中度声门下狭窄，正压通气时狭窄消失。FOB结果提示她因颈部囊性淋巴管瘤的外部压迫而患有获得性气管软化。因此，为避免气管软化恶化，我们未进行气管插管或气管切开术，因为这可能会引发气管水肿、变形以及随后气道狭窄的进一步恶化。尽管DEX的剂量高于推荐剂量，但高剂量DEX在小儿FOB中导致了充分的镇静和镇痛，且无呼吸窘迫或血流动力学不稳定。我们认为DEX对气道困难且需要保持气道平滑肌张力和自主呼吸的婴儿有用。
