The Role of Dexmedetomidine in Awake Tracheotomies

Objective Understand the different types of sedation and anesthesia (to include dexmedetomidine) used during awake tracheotomies along with side effects. Demonstrate how dexmedetomidine has been safely used at our institution to provide analgesia and sedation without compromising respiratory drive during awake tracheotomies. Method We performed a retrospective chart review of awake tracheotomies at our institution between 2008 and 2011. We reviewed operative reports, anesthesia records, and postoperative follow‐up notes. Patients were divided into groups based on indication for tracheotomy and if dexmedetomidine was used during the procedure. We reviewed complications and performed a cost analysis. Results Sixteen awake tracheotomies were performed at our institution during the observed time period: 9 related to malignancy, 5 due to impending airway obstruction, 1 due to infection, and 1 due to trauma. Dexmedetomidine was used in 6 cases. Ages of patients ranged from 22 to 76 years, with an average age of 53.6 years. No intraoperative complications were reported; however, one of the tracheotomies was performed after a failed planned fiberoptic intubation. Two patients eventually succumbed to their illness postoperatively. A cost analysis was performed demonstrating the variability of medication costs. Conclusion Anesthesia providers at our institution have safely used dexmedetomidine during awake tracheotomies. No complications occurred during these procedures. Although dexmedetomidine is more expensive than other agents, it avoids the respiratory depression of other commonly used anesthetics/analgesics. Further research regarding the use of this medication during awake tracheotomies is needed.