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Background and Aims Peritonsillar abscess is a frequent otolaryngology emergency. Surgical drainage may be necessary and is poorly tolerated by the awake patient. In some cases is necessary to proceed with awake intubation in order to safely secure the airway.
Methods Patient: 32-year-old male, with previous history of drug addiction. Procedure: surgical drainage of tonsilar abcess. Anesthetic plan: because a difficult airway was predictable, an awake intubation with videolaringoscopy (C-MAC® D-blade) was decided. Topicalization of the airway was performed with xylocaine 10% and supplemental oxygen was delivered via a nasal catheter. For sedation a bolus of dexmedetomidine (1mcg/kg) and ketamine (1mg/kg) was administered followed by an infusion with dexmedetomidine (1mcg/kg/h) and ketamine (1mg/kg/h).
Results Videolaringoscopy was possible 10 minutes after the initiation of the infusion. After confirmation of good visualization of both abcess and vocal cords rapid sequence intubation was initiated, with administration of propofol (1mg/kg) and rocuronium (1,2mg/kg). After 1 minute, a new videolaringoscopy and sucessful orotraqueal was performed. The procedure as well as the emergence went uneventful.
Conclusions The combination of dexmedetomidine and ketamine, not the most common in awake intubation, is a valuable one, as both drugs induce sedation and analgesia without depressing respiratory function or airway protection reflexes. When it comes to airway management in awake intubation, fibreoptic intubation has been considered the technique of choice, but intubation with videolaryngoscope should be considered since it yields high sucess rates in difficult airways.
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