Monitored anesthesia care with dexmedetomidine and remifentanil during cardiac catheterization in a patient with Duchenne muscular dystrophy and malignant hyperthermia susceptibility

Sedation during invasive procedures is frequently required not only to provide appropriate humanitarian care, but also to facilitate the completion of invasive procedures. Although the current sedative agents are generally safe and effective, adverse effects may occur especially in patients with co-morbid diseases. We present the successful use of a combination of dexmedetomidine and remifentanil to provide sedation (monitored anesthesia care) during cardiac catheterization and coronary angiography in an 11 years old patient with Duchenne muscular dystrophy. Co-morbid conditions included depressed myocardial function, a recent concern of coronary artery insufficiency, a family history of malignant hyperthermia, and impaired respiratory function. Dexmedetomidine was administered as an infusion starting at 0.7 μg/ kg/hour without a loading dose, while remifentanil was administered as an infusion of 0.1 µg/kg/min. There was no patient response to local infiltration of the groin or placement of the arterial catheter for coronary angiography. The patient tolerated the procedure well without adverse effects. The combination of dexmedetomidine and remifentanil for monitored anesthesia care in the pediatric patient is discussed and the potential efficacy of this combination for procedural sedation is reviewed.