Table 2.

Sedation and anesthetic protocol.

Case	Diagnostic imaging	Surgical anesthetic protocol	Temporary tracheostomy	Suture removal
1	Heavy sedation with ketamine, midazolam, and dexmedetomidine. No intubation performed	Ketamine, midazolam, and dexmedetomidine premedication. Induction with alfaxalone	Yes, no complications	Sedation with dexmedetomidine IM
2	Heavy sedation with butorphanol, midazolam, and dexmedetomidine. No intubation performed	Methadone and atropine premedication. Induction with ketamine and midazolam (same protocol for both surgeries)	Yes (right side), no complications	No sedation needed
			Second surgery: normal intubation for the left side.
3	Heavy sedation with midazolam and dexmedetomidine with intermittent propofol administration. No intubation performed	Methadone premedication. Induction with ketamine and midazolam	Yes, no complications	Not performed at UC Davis
4	Heavy sedation with alfaxalone, butorphanol, and midazolam. No intubation performed	Methadone, atropine, and dexmedetomidine premedication. Induction with ketamine and midazolam	Yes, no complications	Not performed at UC Davis
5	Anesthesia with oral intubation using a stylet. Premedication with butorphanol and atropine. Induction with alfaxalone and midazolam	Alfaxalone, hydromorphone, atropine premedication. Induction with alfaxalone and midazolam	No, endotracheal tube passed using a stylet	No sedation needed
6	Heavy sedation with butorphanol and dexmedetomidine. No intubation performed	Dexmedetomidine and hydromorphone premedication. Induction with ketamine and midazolam	Yes, no complications	No sedation needed
7	Heavy sedation with dexmedetomidine. No intubation performed	Methadone and dexmedetomidine premedication. Induction with ketamine and midazolam (same protocol for both surgeries)	Yes, no complications	Sedation with gabapentin orally for both suture removal appointments
			Second surgery: endotracheal tube passed via endoscopic guided stylet placement

*In all cases standard drug doses were used.