Sudden Postoperative Respiratory Collapse in a Young Patient Following Spinal Anesthesia With Dexmedetomidine Undergoing Open Reduction and Internal Fixation With Tibial Intramedullary Nailing: A Case Report

Background: As an adjuvant to spinal anesthesia, intrathecal dexmedetomidine is being is used more to improve postoperative analgesia and extend the duration of block. This is a case of sudden postoperative respiratory collapse and altered consciousness following intrathecal dexmedetomidine used during open reduction and internal fixation with tibial intramedullary nailing surgery. A healthy 27-year-old male underwent open reduction and internal fixation (ORIF) with intra Case: medullary nailing of a left tibial nonunion under spinal anesthesia using 3 milliliters of 0.5% hyperbaric Bupivacaine plus 5 microgram Dexmedetomidine. The intraoperative course was unremarkable. The postoperative period was complicated by sudden hypoxia (oxygen saturation dropped to 70% on 10 Liters per minute oxygen) and a Glasgow Coma Scale of 3 (Eye 1, Verbal 1, Motor 1). Computed tomography (CT) of the brain and CT pulmonary angiogram (CTPA) were normal. The patient was intubated, managed in the intensive care unit (ICU), and extubated the same afternoon once fully conscious, before being transferred to the ward one day after being admitted to intensive care unit (ICU). This case highlights the Conclusion: potential for severe central nervous system effects, including respiratory depression, following routine intrathecal dexmedetomidine use, emphasizing the need for vigilant monitoring and readiness for airway intervention.