Dexmedetomidine as sole agent for awake fiberoptic intubation in a patient with local anesthetic allergy

A series of case reports acknowledges the efficacy of dexmedetomidine as a sole sedative for awake intubations in managing a critical airway. However, most case reports documented in the literature used topicalization of the oropharynx either via nebulized lidocaine or the spray-as-you-go technique with either 2% or 4% lidocaine spray to achieve successful intubation. The following case report presents an intensive care unit (ICU) patient with a critical airway who had a true documented allergy to local anesthetics. This case report demonstrates that dexmedetomidine appears to be useful for sedation during awake intubations in critical airways, without the need for airway topicalization. The ability of dexmedetomidine to act as a sedative, anxiolytic, analgesic, and antisialagogue without causing respiratory depression is promising to the field of anesthesiology. Additional studies are needed to elucidate its potential role as the sole agent for awake fiberoptic intubation.