Experience with dexmedetomidine in pediatric tubeless anesthesia for endoscopic airway surgery: A report of three cases

Airway surgeries in children are very challenging to the anesthesiologist because of the nature of thesurgeries as well as the unique characteristics of the patient population involved. While the surgeon wantsa ‘free and uninterrupted field’ for ease of access, the anesthetist has to ensure continuous oxygenationand ventilation to a patient whose respiratory dynamics are very volatile. The challenges are compoundedby the factor of the shared airway. Dexmedetomidine has emerged as a popular anesthetic agent in varioussettings. However, there are not many reports of its use in children for endoscopic airway surgeries as ananesthetic. The main reason limiting use of dexmedetomidine in children is its common side effects ofbradycardia and hypotension, of which bradycardia can be critical in this age group.We describe our experience with using dexmedetomidine for spontaneous respiration anesthesia inthree children undergoing complex endoscopic airway surgeries.