Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation. Airway regional blocks
which are commonly used to facilitate awake intubation are sometimes impossible or forbidden. On the other hand deep
sedation could be life threatening in the case of compromised airway. The aim of this study is evaluating "Subcutaneous Dissociative
Conscious Sedation" (sDCS) as an alternative method to airway regional blocks for awake intubation. In this prospective, non-
randomized study, 30 patients with predicted difficult airway (laryngeal tumors), who were scheduled for direct laryngoscopic
biopsy (DLB), underwent "Subcutaneous Dissociative Conscious Sedation" (sDCS) exerted by intravenous fentanyl 3-4ug/kg and
subcutaneous ketamine 0.6-0.7 mg/kg. The tongue and pharynx were anesthetized with lidocaine spray (4%). 10 minutes after
a subcutaneous injection of ketamine direct laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered
if the patient wasn't cooperative enough for laryngoscopy. Patients were evaluated for hemodynamic stability (heart rate and
blood pressure), oxygen saturation (Spo
), patient cooperation (obedient to open the mouth for laryngoscopy and the number
of tries for laryngoscopy), patient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration
before laryngoscopy). Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and
then laryngoscopy was performed successfully on the second try. All patients were cooperative enough during laryngoscopy.
Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo
< 90%) didn't occur in any
patient. In conclusion Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable and
safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication rate for regional airway blocks.
Mihan J. Javid has completed her M.D at the age of 24 from Tabriz University of Medical Sciences and post-doctoral studies from Tabriz University of Medical Sciences. She is director of Intensive Care Unit. She has more than 20 publications and more than 6 innovations in medicine. She won the award of ?The Best Researcher? in Iranian festival of the Best woman researcher in 2004.
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