Abstract
Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesiologist was satisfied by the quality of patient’s cooperation for laryngoscopy in both groups. Conclusion: Subcutaneous dissociative conscious sedation is comparable with general anesthesia to provide desirable situation for laryngoscopy and tracheal intubation.
Highlights
Laryngoscopy and tracheal intubation are evaluated as painful procedures and in the presence of inadequate anesthesia result in sympathetic overactivity and considerable increase in heart rate and blood pressure [1,2]
Induction doses of most hypnotics and intravenous anesthetics are accompanied by a period of respiratory depression and in the case of difficult airway the necessity to maintain spontaneous ventilation restricts using intravenous anesthetics and neuromuscular blocking agents [2,3,4]
Despite the advantages mentioned above unfavorable effects such as bleeding, nerve damage, intravenous injection of local anesthetic, elimination of highly effective airway protective reflexes and the absence of enough access to anatomical landmarks and neck and upper airway pathologies such as obesity, tumors and burns encourage anesthesiologists to design safe alternatives to general anesthesia and airway regional blocks [5,6,7]
Summary
Laryngoscopy and tracheal intubation are evaluated as painful procedures and in the presence of inadequate anesthesia result in sympathetic overactivity and considerable increase in heart rate and blood pressure [1,2].General anesthesia using intravenous anesthetics with or without neuromuscular blocking agents is commonly used to facilitate laryngoscopy and tracheal intubation and reducing sympathetic overactivity [2]. Different methods have been recommended to provide adequate sedation and desirable situation for awake endotracheal intubation and respiratory depression is a common concerning complication of these experienced methods [8,9,10,11,12,13,14,15,16]. The variety of these experienced methods indicates the importance of respiratory depression in patients with predicted difficult airway and the necessity of substitution of an alternative respiratory preserving method of anesthesia instead of traditional methods
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