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Guinness F, Coleman M, Gillbride M. Dexmedetomidine sedation for a dental extraction in a patient with known difficult airway. Anaesth Rep 2022; 10:e12184. [PMID: 35983243 PMCID: PMC9372726 DOI: 10.1002/anr3.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/08/2022] Open
Abstract
Fibrodysplasia ossificans progressiva is an autosomal dominant condition that causes cervical spine fusion and ankylosis of the temporomandibular joint, resulting in anaesthetic challenges. Awake tracheal intubation with flexible bronchoscopy is recommended for general anaesthetics required by patients with this disease. This case report describes the novel approach of using dexmedetomidine sedation in combination with local anaesthesia to allow dental extraction of the fifth and seventh upper left teeth in a patient with fibrodyplasia ossificans progressive, who had a known difficult airway and profound thrombocytopenia. This procedure was not previously tolerated by the patient under local anaesthesia alone. The use of dexmedetomidine was successful in facilitating completion of the procedure with a high degree of patient satisfaction. We discuss the advantages of dexmedetomidine over other sedative agents due to its minimal effects on respiratory drive and airway muscle tone. We highlight the use of dexmedetomidine for complex cases such as this, where tracheal intubation is potentially challenging, but the procedure itself could be managed under sedation and local anaesthesia.
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Affiliation(s)
- F. Guinness
- Department of AnaesthesiaUniversity Hospital LimerickLimerickIreland
| | - M. Coleman
- Department of AnaesthesiaUniversity Hospital LimerickLimerickIreland
| | - M. Gillbride
- Department of Oral and Maxillofacial SurgeryUniversity Hospital LimerickLimerickIreland
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Smilde BJ, Botman E, de Ruiter RD, Smit JM, Teunissen BP, Lubbers WD, Schwarte LA, Schober P, Eekhoff EMW. Monitoring and Management of Fibrodysplasia Ossificans Progressiva: Current Perspectives. Orthop Res Rev 2022; 14:113-120. [PMID: 35480068 PMCID: PMC9035442 DOI: 10.2147/orr.s337491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP), sometimes known as myositis ossificans progressiva, is an ultra-rare disease in which bone is formed in muscular tissue, tendons and ligaments. This is known as heterotopic ossification (HO). FOP is caused by a heterozygous mutation in the highly conserved ACVR1/ALK2 gene which affects about 1 in 1.5–2 million individuals. At birth, patients with the predominant R206H mutation only exhibit a bilateral hallux valgus. During childhood, heterotopic bone formation develops in a typical pattern, affecting the axial muscles first before appendicular body parts are involved. HO can start spontaneously but is often elicited by soft tissue trauma or medical procedures. After soft tissue injury, an inflammatory process called a flare-up can start, followed by the formation of HO. HO leads to a limited range of motion, culminating in complete ankylosis of nearly all joints. As a result of HO surrounding the thorax, patients often suffer from thoracic insufficiency syndrome (TIS). TIS is the most common cause of a limited life expectancy for FOP patients, with a median life expectancy of 56 years. Management is focused on preventing soft-tissue injury that can provoke flare-ups. This includes prevention of iatrogenic damage by biopsies, intramuscular injections and surgery. Anti-inflammatory medication is often started when a flare-up occurs but has a poor basis of evidence. Several forms of potential treatment for FOP are being researched in clinical trials. Progression of the disease is monitored using CT and 18F-NaF PET/CT combined with functional assessments. Patients are regularly evaluated for frequently occurring complications such as restrictive lung disease. Here, we review the current management, monitoring and treatment of FOP.
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Affiliation(s)
- Bernard J Smilde
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Endocrinology, Amsterdam, the Netherlands
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - Esmée Botman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Endocrinology, Amsterdam, the Netherlands
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - Ruben D de Ruiter
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Endocrinology, Amsterdam, the Netherlands
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - Jan Maerten Smit
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
| | - Berend P Teunissen
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Wouter D Lubbers
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands
| | - Lothar A Schwarte
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands
| | - Patrick Schober
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands
| | - E Marelise W Eekhoff
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Endocrinology, Amsterdam, the Netherlands
- Amsterdam UMC, Amsterdam Bone Center, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
- Correspondence: E Marelise W Eekhoff, Department of Internal Medicine section Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands, Tel +31 204440588, Email
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