Transtracheal Block Combined with Dexmedetomidine in ASA III Patients Undergoing Interventional Bronchoscopy: A Longitudinal Observational Study of Four Patients

Abstract

Background. Fiberoptic bronchoscopy (FOB) in patients with American Society of Anesthesiologists (ASA) physical status III is anesthetically demanding. General anesthesia can cause alveolar derecruitment and hemodynamic collapse, whereas superficial topicalization often fails to block lower airway cough receptors.

Objective. To describe the efficacy, hemodynamic stability, and respiratory course of a protocol that combines transtracheal block (TTB) with dexmedetomidine infusion in ASA III patients undergoing FOB.

Methods. Four consecutive ASA III men (aged 43–66 years) with severe pulmonary disease received dexmedetomidine (1 µg/kg over 10 minutes, then 0.2–0.7 µg/kg/h) and a cricothyroid transtracheal injection of 20 mg (1 mL) of 2% lidocaine. Hemodynamics, oxygenation, cough (visual analog scale [VAS], 0–10), and sedation depth were recorded at predefined milestones.

Results. All four bronchoscopies were completed without conversion to general anesthesia. Mean arterial pressure (baseline 97.5 ± 8.3 mmHg; nadir 87.5 ± 5.6 mmHg) and heart rate (baseline 84.8 ± 7.3 bpm; nadir 76.0 ± 6.9 bpm) stayed within 13.3% of baseline without vasoactive support. Spontaneous ventilation was preserved (respiratory rate 14–18 breaths/min), with no desaturation (nadir SpO₂ 94–97%). Cough was minimal (VAS ≤ 1/10; median 0), which allowed transbronchial biopsy. All patients left the intensive care unit within 24 hours.

Conclusion. In these four patients, TTB with dexmedetomidine provided adequate airway anesthesia while preserving spontaneous ventilation and hemodynamic stability, which supports feasibility; controlled studies are needed.