Tracheal resection in the morbidly obese patient: the role of dexmedetomidine

We present a case of respiratory distress in a morbidly obese woman, which was complicated by a severe tracheal stenosis of the third to sixth cartilage. She had a history of sleep apnea and could only breathe sitting upright. An anesthetic, technique using dexmedetomidine was selected because of its properties of anxiolysis and sedation, with lack of respiratory depression. No intraoperative or postoperative opioids were required. Dexmedetomidine in high doses offers another approach to managing the patient with a compromised airway. Opioids were avoided in this patient, who was at major risk of postoperative respiratory depression and sleep apnea.