Topical Dexmedetomidine Pharyngeal Spraying Mitigates Severe Postoperative Sore Throat Following Rigid Bronchoscopy Despite Vocal Cord Injury: A Case Report and Clinical Insight

Severe postoperative sore throat (POST) following rigid bronchoscopy (RB) is a common complication, with incidence rates reaching 62% due to mucosal trauma from large-diameter scopes. Conventional preventive measures often prove inadequate. This case report demonstrates the efficacy of topical dexmedetomidine (DEX) pharyngeal spraying in a 36-year-old male with recurrent tracheal adenoid cystic carcinoma and refractory POST after three prior RBs. Under bronchoscopic guidance, 48 µg of DEX, prepared by diluting 0.5 mL of 100 µg/mL commercial DEX solution in 4.5 mL of sterile saline, was sprayed onto both vocal cords before RB insertion. The POST severity was assessed using a validated four-point scale (0 = no pain; 1 = minimal discomfort; 2 = moderate pain affecting swallowing; 3 = severe pain with voice changes). Despite intraoperative vocal cord injury, the patient showed remarkable POST reduction (scores: 0 at 0/2/8h; 1 at 24h; 0 at 48h) and improved sleep quality, with stable hemodynamics and no adverse effects. The patient's history served as an intrinsic control, with prior RBs consistently causing severe POST despite conventional therapies. This targeted approach achieved localized anti-inflammatory effects through DEX's cytokine suppression while avoiding systemic risks. The intervention's success despite vocal cord trauma highlights its clinical robustness. Compared to systemic DEX, topical delivery uses lower doses while maintaining efficacy, offering advantages for complex airway procedures. These findings suggest topical DEX spraying may provide a novel preventive strategy in RB, particularly for high-risk patients. Controlled trials are warranted to validate this approach.