Article Text

Download PDFPDF

#35867 Ketodex and regional anesthesia in a pediatric patient with a challenging airway: a case report
  1. Catarina Petiz1,
  2. António Palha Ribeiro2 and
  3. Céline Marques3
  1. 1Anesthesiology, Centro Hospitalar Universitario Lisboa Norte, Lisboa, Portugal
  2. 2Anesthesiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
  3. 3Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Ketodex is effective in achieving sedation and has a favorable safety profile in pediatric patients undergoing MRI and invasive procedures, while producing minimal adverse effects.

Methods A 6-year-old female patient, ASA III status, weighing 21 kg, with a history of type I mucopolysaccharidosis was proposed for bilateral median nerve release with tourniquet due to carpal tunnel syndrome. Preoperative evaluation showed indicators of a potentially difficult airway (Mallampati class IV, retrognathia, limited neck extension, macroglossia). The patient was proposed for locoregional anesthesia with sedation and standard ASA+BIS monitoring. A loading dose of ketamine+dexmedetomidine (‘ketodex’) was administered, according to the hospital protocol, consisting of 1 mg/kg of ketamine and 1 µg/kg of dexmedetomidine over 10 minutes. The patient maintained SpO2>98% with 2 L/min of nasal cannula, hemodynamic stability, with BIS 70-80 on EEG. Bilateral costoclavicular blockade was performed under ultrasound guidance with 5 mL of 0.2% ropivacaine + 5 mL of 1.5% mepivacaine. Sedation was maintained with a titrated dose of ketodex according to BIS (maximum dose 1 µg/kg/h). Administration of 300 mg of paracetamol and 10 mg of ketorolac at the end.

Results The procedure was completed without complications. The patient was transferred to the post-anesthesia care unit without pain complaints, hemodynamically stable, and with SpO2 ~99% with 1 L/min of nasal cannula.

Conclusions This case underscores the importance of tailored anesthetic management in pediatric patients with comorbidities and difficult airway. Effective implementation of clinical guidance protocols and in-depth knowledge of drug pharmacology were crucial for the successful anesthetic management in this case report.

  • difficult airway
  • pediatric surgery
  • ketodex

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.