TITLE:
The Feasibility of Endotracheal Intubation with Subcutaneous Dissociative Conscious Sedation versus General Anesthesia: A Prospective Randomized Trial
AUTHORS:
Sanaz Shabani, Mihan J. Javid, Jayran Zebardast
KEYWORDS:
Difficult Airway; Ketamine; Laryngoscopy; Subcutaneous Dissociative Conscious Sedation; Tracheal Intubation
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.4 No.2,
January
29,
2014
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.