Open accessCase reportFirst published online 2013-6
A Case Report on the Anaesthetic Management of Dexmedetomidine-Induced Sleep Endoscopy and Transoral Robotic Surgery for the Treatment of Obstructive Sleep Apnoea
A 44-year-old male presented with severe obstructive sleep apnoea (OSA) which persisted despite septoplasty, inferior turbinectomy, uvulopalatopharyngoplasty and tonsillectomy. He underwent a diagnostic drug-induced sleep endoscopy which showed his tongue base as another source of obstruction. This was followed by the first transoral robotic surgery (TORS) of the tongue base performed in our centre. We discuss the novel use of dexmedetomidine for drug-induced sleep endoscopy and the anaesthetic management of this challenging group of patients undergoing this new surgical procedure.
PoirierPGilesTDBrayGAHongYSternJSPi-SunyerFX. American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss: An update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation2006;113(6):898–918.
2.
SullivanCEIssaFGBerthon-JonesMEvesL. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet1981;1(8225):862–5.
3.
ChanASLeeRWCistulliPA. Dental appliance treatment for obstructive sleep apnea. Chest2007;132(2):693–9.
4.
CroftCBPringleM. Sleep nasoendoscopy: A technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci1991;16(5):504–9.
5.
AbdullahVJWingYKvan HasseltCA. Video sleep nasoendoscopy: The Hong Kong experience. Otolaryngol Clin North Am2003;36(3):461–71.
6.
RoblinGWilliamsARWhittetH. Target-controlled infusion in sleep endoscopy. Laryngoscope2001;111(1):175–6.
CamilleriAERamamurthyLJonesPH. Sleep nasoendoscopy: What benefit to the management of snorers?J Laryngol Otol1995;109(12):1163–5.
9.
KaskinoroKMaksimowALangsjoJAantaaRJaaskelainenSKaistiK. Wide inter-individual variability of bispectral index and spectral entropy at loss of consciousness during increasing concentrations of dexmedetomidine, propofol, and sevoflurane. British Journal of Anaesthesia2011;107(4):573–80.
10.
KorogluADemirbilekSTeksanHSagirOButAKErsoyMO. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: Preliminary results. British Journal of Anaesthesia2005;94(6): 821–4.
11.
AlhashemiJA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. British Journal of Anaesthesia2006;96(6):722–6.
12.
BellevilleJP. Effects of intravenous dexmedetomidine in humans: Sedation, ventilation, and metabolic rate. Anesthesiology1992;77(6):1125–33.
13.
GrossJBBachenbergKLBenumofJLCaplanRAConnisRTCotéCJ. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: A report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology2006;104(5):1081–93.
14.
SiyamMABenhamouD. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg2002;95(4):1098–102.
15.
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology2003;98(5):1269–7.
16.
BamgbadeOAAlfaJA. Dexmedetomidine anaesthesia for patients with obstructive sleep apnoea undergoing bariatric surgery. Eur J Anaesthesiol2009;26(2):176–7.
17.
BoldenNSmithCEAuckleyDMakarskiJAvulaR. Perioperative complications during use of an obstructive sleep apnea protocol following surgery and anesthesia. Anesth Analg2007;105(6):1869–70.
18.
ViciniCDallanICanziPFrassinetiSLa PietraMGMontevecchiF. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: A preliminary report. J Otorhinolaryngol Relat Spec2010;72(1):22–7.
19.
SullivanMJFrostEAMLewMW. Anesthetic care of the patient for robotic surgery. Middle East J. Anaesthesiol2008;19(5):967–82.
20.
IrvineMPatilV. Anaesthesia for robot-assisted laparoscopic surgery. Contin Educ Anaesth Crit Care Pain2009;9(4):125–9.
