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

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.