Dexmedetomidine sedation combined with epidural anesthesia for laparoscopy in a patient with suspected tuberculosis: A case report

RATIONALE: We herein present a case in which satisfactory analgesia and sedation were provided by the combination of epidural anesthesia with dexmedetomidine for exploratory laparoscopy in a patient who was highly suspected to have tuberculosis. This is an optimal anesthesia method to minimize the risk of nosocomial infection, especially in developing countries that lack sterilizers for anesthesia machines. PATIENT CONCERNS: A 45-year-old woman suspected to have active tuberculosis was scheduled to undergo laparoscopy for definitive diagnosis of a pelvic mass. DIAGNOSES: Tuberculosis was diagnosed by exploratory laparoscopy. INTERVENTIONS: The surgery was performed under general anesthesia to prevent pain and discomfort during the procedure. However, ventilation machine used by patients with tuberculosis may have a potential risk of nosocomial infection and need disinfection by a special sterilizer machine even when using a bacterial/viral filter-heat and moisture exchanger. Therefore, the surgery was performed under continuous epidural anesthesia combined with dexmedetomidine. OUTCOMES: The surgery was successfully completed, and pelvic tubercles were confirmed to be caseous necrotic tissue by pathologic examination. The patient began regular antituberculosis treatment after discharging from the gynecology department. LESSONS: We conclude that administration of dexmedetomidine combined with epidural anesthesia can provide comfortable sedation for short laparoscopic procedures in patients with suspected tuberculosis. This technique can minimize the risk of nosocomial infection.