Subcutaneous Dissociative Conscious Sedation (sDCS) a New Approach to Compromised Airway in Mediastinal Masses

Mihan J. Javid, Mohammad B. Rahim, Shahab Rafiian

Associate Professor of Anesthesiology, Department of Anesthesiology and Critical Care, Imam Khomeinee Medical Center, Tehran University of Medical Sciences, Iran.
Department of Thoracic Surgery, Imam Khomeinee Medical Center, Tehran University of Medical Sciences, Iran.

DOI: 10.4236/ojanes.2012.24037                

Abstract

Purpose: Anesthesia and airway management for mediastinal masses are challenging and are accompanied by mortality and morbidity. Avoiding the loss of airway muscular tone in mediastinal masses has been confirmed necessary to avoid airway collapse. Sufficient spontaneous ventilation is of paramount importance in order to reduce the rate of mortality and morbidity. Various anesthetics and anesthesia techniques have been used for maintaining spontaneous ventilation and patent airway. In this report, a successful double lumen endobronchial intubation using “subcutaneous dissociative conscious sedation” as a novel method in the management of compromised airway (a case of a mediastinal mass) is presented. Clinical features: A 42 year- old, 62 Kg man was presented for an open biopsy of a middle mediastinal mass. The patient had a history of chest pain, dyspnea, cough, fever and sweats for 2 months. Regarding to the life threatening nature of mediastinal masses resulting from unpredictable events of airway obstruction and the reported cases of deaths after induction of anesthesia in patients with mediastinal masses and regarding to the importance of not losing muscular tone and keeping airway tone intact in patients with mediastinal masses” subcutaneous Dissociative Conscious Sedation (a novel method of anesthesia)”was selected in order to guarantee the safety of the patient and keep the airway secure. Conclusion: Owing to the characteristics of the “subcutaneous dissociative conscious sedation” this method is suggested as an appropriate substitute to general anesthesia for Endobronchial Double Lumen Intubation in mediastinal masses and compromised airway.

Keywords

Airway Management; Difficult Airway; Low Dose Ketamine; Mediastinal Masses; Subcutaneous Ketamine, Subcutaneous Dissociative Conscious Sedation

Conflicts of Interest

The authors declare no conflicts of interest.

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