Pediatric cardiac catheterization procedure with dexmedetomidine sedation: Radiographic airway patency assessment

Aims: The aim of the study was to measure airway patency objectively during dexmedetomidine sedation under radiographic guidance in spontaneously breathing pediatric patients scheduled for cardiac catheterization procedures. Subjects and Methods: Thirty-five patients in the age group 5-10 years scheduled for cardiac catheterization procedures were enrolled. All study patients were given loading dose of dexmedetomidine at 1 mu g/kg/min for 10 min and then maintenance dose of 1.5 mu g/kg/h. Radiographic airway patency was assessed at the start of infusion (0 min) and after 30 min. Antero-posterior (AP) diameters were measured manually at the nasopharyngeal and retroglossal levels. Dynamic change in airway between inspiration and expiration was considered a measure of airway collapsibility. Patients were monitored for hemodynamics, recovery time and complications. Statistical Analysis: Student paired t-test was used for data analysis. P < 0.05 was considered significant. Results: Minimum and maximum AP diameters were compared at 0 and 30 min. Nasopharyngeal level showed significant reduction in the minimum (6.27 +/- 1.09 vs. 4.26 +/- 1.03, P < 0.0001) and maximum (6.51 +/- 1.14 vs. 5.99 +/- 1.03, P < 0.0001) diameters. Similarly retroglossal level showed significant reduction in the minimum (6.98 +/- 1.09 vs. 5.27 +/- 1.15, P < 0.0001) and maximum (7.49 +/- 1.22 vs. 6.92 +/- 1.12, P < 0.0003) diameters. The degree of collapsibility was greater at 30 min than baseline (P < 0.0001). There was a significant decrease in heart rate (P < 0.0001), and the average recovery time was 39.86 +/- 12.22 min. Conclusion: Even though airway patency was maintained in all children sedated with dexmedetomidine, there were significant reductions in the upper airway dimensions measured, so all precautions to manage the airway failure should be taken.