[Postoperative management and extubation under sedation using dexmedetomidine in a patient with old myocardial infarction after carotid endarterectomy].

A patient with old myocardial infarction was sedated using dexmedetomidine after carotid endarterectomy with the intention of protecting the wound. The patient was kept intubated and sedated overnight. The next morning, he was weaned off from the respirator easily and extubated under sedation using 0.7 microg x kg(-1) x h(-1) of dexmedetomidine. The sedation was maintained over 24 hours after the extubation. No complications such as hypoxia occurred and he did not suffer from endotracheal tube placed during the period of sedation. Major hemodynamic changes were not observed under the sedation, particularly during bolus infusion, and endotracheal suction as well as extubation. Therefore, postoperative care was easy and without any complications such as wound dehiscence and angina pectoris syndrome. It is felt that dexmedetomidine is safe and suited for extubation under sedation because it has little effect on respiration. However, an increased dose of dexmedetomidine or addition/substitution with a different drug may necessary if the deeper sedation or muscle relaxant is necessary in patients with unstable hemodynamics or severe body movement at the period except peri-extubation.