Anesthesia for percutaneous transluminal angioplasty (PTA) involves a high-risk population having a broad spectrum of pain character and intensity. This study delved the anesthetic efficacy of dexmedetomidine versus midazolam, when used with remifentanil. Seventy patients scheduled for femoropopliteal PTA were randomized into two groups receiving either intermittent midazolam boluses (0.03–0.05 mg/kg) (MR group) or dexmedetomidine 0.2–0.7 μg/kg/h after a loading dose of 1.0 μg/kg for 10 min (DR group), both with remifentanil. The primary endpoint was the patients’ satisfaction (1–5, 5; extremely satisfied). Secondary endpoints included postprocedural pain scores (0–10, 10; worst imaginable pain) and adverse events. The satisfaction level of patients was significantly greater in the DR group compared with the MR group (4.0 [3.0, 5.0] versus 4.0 [2.0, 5.0] p = 0.021). The number of patients having a postprocedural pain score of at least 3 was significantly greater in the MR group compared with the DR group (10 [29%] versus 2 [6%], p = 0.013). The number of patients with hypotensive episodes was higher in the DR group (5 [14.7%] versus 0, p = 0.025), which could all be restored with ephedrine. The use of dexmedetomidine in conjunction with remifentanil may be a safe option that provides excellent patient satisfaction while potentially attenuating postprocedural pain.

Background/Objectives: Ultrasound-guided fascial plane blocks have emerged as opioid-sparing analgesic strategies for cardiac surgery; however, evidence regarding combined block techniques remains limited. This randomized controlled trial evaluated the analgesic efficacy of combined pectoserratus plane block (PSPB) and pecto-intercostal fascial plane block (PIFB) in patients undergoing cardiac surgery via median sternotomy. Methods: Sixty-two adult patients undergoing cardiac surgery via median sternotomy were randomized to either a block group receiving bilateral PSPB and PIFB after anesthetic induction or a control group receiving conventional analgesia alone. The primary outcome was postoperative visual analog scale (VAS) pain score at 6, 12, 24, and 48 h after surgery. Secondary outcomes included Korean version of Quality of Recovery-15 (QoR-15K) scores, total opioid consumption, rescue analgesic dose, time to first rescue analgesia, extubation time, intensive care unit (ICU) stay, hospital stay, and the incidence of postoperative nausea and vomiting. Results: Fifty-four patients were included in the final analysis. Postoperative VAS scores did not differ significantly between groups after Bonferroni correction for repeated measurements. No significant overall between-group effect was observed in repeated-measures ANOVA. ICU stay was statistically shorter in the block group, although the absolute difference was small and of uncertain clinical relevance. No significant differences were observed in the remaining secondary outcomes. Conclusions: Combined PSPB and PIFB did not reduce postoperative pain or improve recovery outcomes after cardiac surgery via median sternotomy. Early postoperative pain scores were numerically higher in the block group, although these differences were not statistically significant after correction for multiple comparisons. The incremental analgesic benefit of combined fascial plane blocks may therefore be limited in this clinical setting.

Primary laryngeal cancers causing critical airway stenosis pose significant challenges to airway management. Although flexible bronchoscope guided awake intubation is generally recommended for anticipated difficult airways, the presence of a friable and obstructive mass may render this technique ineffective. We report the case of a 69‐year‐old male who presented with dyspnea and stridor due to a T4a transglottic carcinoma involving the vocal cords and anterior commissure. Despite a carefully planned awake flexible bronchoscopic intubation, advancement of the endotracheal tube was impossible due to the tumor’s mass effect. Consequently, the airway management strategy was promptly changed to an emergency surgical tracheostomy under local anesthesia, which was successfully performed by an otolaryngologist on standby without perioperative complications. This case highlights the limitations of noninvasive techniques in the presence of severe anatomical distortion and emphasizes the importance of multidisciplinary preparation for immediate front‐of‐neck access in high‐risk laryngeal cancer patients.