Subcutaneous Dissociative Conscious Sedation a new approach to Endobronchial Intubation: Awake Endobronchial Intubation

Introduction: Lung isolation and one lung ventilation are inseparable components of thoracic surgery and thoracic anesthesia to provide patent airway and adequate surgical exposure. Endobronchial intubation is usually done under general anesthesia. The aim of this study is the evaluation of the feasibility of awake Double Lumen endobronchial intubation. Subcutaneous Dissociative conscious sedation (as a recently introduced method) is defined as using subcutaneous injection of ketamine in conjunction with intravenous narcotics and topical oropharyngeal anesthesia to achieve an acceptable level of sedation, amnesia and pain relief for airway manipulation. This clinical trial was planned in order to evaluate subcutaneous Dissociative Conscious Sedation versus general anesthesia for endobronchial intubation. Methods and Materials: This randomized clinical trial was conducted on 100 patients. In group A, patients were administered ketamine subcutaneously and morphine sulfate as premedication and general anesthesia was induced by administration of Na-thiopental and atracurium. In group B patients underwent DCS and were on spontaneous ventilation and received supplemental oxygen by simple mask before intubation. Hemodynamic variables were recorded. Side effects were recorded as well. Results: In comparison to general anesthesia there was no significant hemodynamic instability, and no statistically significant increase in the incidence of nausea and vomiting was detected in this method. Despite cooperation during laryngoscopy and endobronchial intubation all the patients were amnestic. Conclusion: Dissociative conscious sedation is an acceptable alternative to general anesthesia for endobronchial intubation.