# Dexmedetomidine-Assisted Anesthetic Management of Empyema in a High-Risk Parturient With Cardiopulmonary Failure: A Case Report

## TL;DR

A high-risk pregnant woman with empyema and cardiopulmonary failure successfully underwent CT-guided drainage with dexmedetomidine, highlighting the need for individualized care in such cases.

## Contribution

Demonstrates the use of dexmedetomidine in a pregnant patient and highlights CT-guided drainage as a viable alternative to VATS in high-risk cases.

## Key findings

- CT-guided chest tube drainage was successfully used in a critically ill pregnant patient with empyema.
- Dexmedetomidine was safely administered for anesthetic management in this high-risk pregnancy.
- Multidisciplinary decision-making is crucial for managing complex cases of empyema in pregnant patients.

## Abstract

Empyema, characterized by purulent fluid collection in the pleural space, presents treatment challenges. Video-assisted thoracoscopic surgery (VATS) and computed tomography (CT)-guided chest tube drainage are the main options, each with distinct anesthetic considerations. We describe the case of a 33-year-old pregnant woman (G8P8) at 29 weeks of gestation with a large left-sided empyema, cardiopulmonary failure, and a history of complex obstetric complications, including seven previous cesarean sections, placenta accreta, and placenta previa. After thorough multidisciplinary discussions and careful risk-benefit reviews, CT-guided chest tube drainage with monitored anesthesia care was chosen over VATS. The procedure was ultimately successful, emphasizing the need for individualized, multidisciplinary decision-making in critically ill pregnant patients. CT-guided drainage emerges as a viable alternative to VATS in select cases. Additionally, this case provides an example of using dexmedetomidine in a pregnant patient; this is significant as there is minimal research and reporting in this area of use.