Background: Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation.\r\nAirway regional blocks which are commonly used to facilitate awake intubation are sometimes impossible or\r\nforbidden. On the other hand deep sedation could be life threatening in the case of compromised airway.\r\nThe aim of this study is evaluating ââ?¬Å?Subcutaneous Dissociative Conscious Sedationââ?¬Â (sDCS) as an alternative method\r\nto airway regional blocks for awake intubation.\r\nMethods: In this prospective, non-randomized study, 30 patients with predicted difficult airway (laryngeal tumors),\r\nwho were scheduled for direct laryngoscopic biopsy (DLB), underwent ââ?¬Å?Subcutaneous Dissociative Conscious\r\nSedationââ?¬Â (sDCS) exerted by intravenous fentanyl 3-4ug/kg and subcutaneous ketamine 0.6-0.7 mg/kg. The tongue\r\nand pharynx were anesthetized with lidocaine spray (4%). 10 minutes after a subcutaneous injection of ketamine\r\ndirect laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered if the patient wasnââ?¬â?¢t\r\ncooperative enough for laryngoscopy.\r\nPatients were evaluated for hemodynamic stability (heart rate and blood pressure), oxygen saturation (Spo2),\r\npatient cooperation (obedient to open the mouth for laryngoscopy and the number of tries for laryngoscopy),\r\npatient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration before\r\nlaryngoscopy).\r\nResults: Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and\r\nthen laryngoscopy was performed successfully on the second try. All patients were cooperative enough during\r\nlaryngoscopy. Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo2<\r\n90%) didnââ?¬â?¢t occur in any patient.\r\nConclusions: Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable\r\nand safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication\r\nrate for regional airway blocks.
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