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

Abstract Full-Text HTML XML Download Download as PDF (Size:255KB) PP. 166-169
DOI: 10.4236/ojanes.2012.24037    3,834 Downloads   6,180 Views   Citations

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.

Cite this paper

M. Javid, M. Rahim and S. Rafiian, "Subcutaneous Dissociative Conscious Sedation (sDCS) a New Approach to Compromised Airway in Mediastinal Masses," Open Journal of Anesthesiology, Vol. 2 No. 4, 2012, pp. 166-169. doi: 10.4236/ojanes.2012.24037.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] U. B. Prakash, M. D. Abel and R. D. Hubmayer, “Mediastinal Mass and Tracheal Obstruction during General Anesthesia,” Mayo Clinic Proceedings, Vol. 63, No. 10, 1988, pp. 1004-1011.
[2] R. G. Azizkhan, D. L. Dudgeon, J. R. Buck, P. M. Colombani, M. Yaster, D. Nichols, C. Civin, S. S. Kramer and J. A. Haller Jr., “Lifethreatening Airway Obstruction as a Complication to the Management of Mediastinal Masses in Children,” Journal of Pediatric Surgery, Vol. 20, No. 6, 1985, pp. 816-822.
[3] D. R. Northrip, B. K. Bohman and K. Tsueda, “Total Airway Occlusion and Superior Vena Cava Syndrome in a Child with Anterior Mediastinal Tumour,” Anesthesia & Analgesia, Vol. 65, No. 10, 1986, pp. 1079-1082.
[4] D. Bitter, “Respiratory Obstruction Associated with Induction of General Anesthesia in a Patient with Mediastinal Hodgkin’s Disease,” Anesthesia & Analgesia, Vol. 54, No. 3, 1975, pp. 399-403.
[5] H. Levin, S. Bursztein and M. Heifetz, “Cardiac Arrest in a Child with an Anterior Mediastinal Mass,” Anesthesia & Analgesia, Vol. 64, No. 11, 1985, pp. 1129-1130.
[6] L. Létourneau, Y. Lacasse, D. C?té and J. S. Bussières, “Perioperative Cardiorespiratory Complications in Adults with Mediastinal Mass: Incidence and Risk Factors,” Anesthesiology, Vol. 100, No. 4, 2004, pp. 826-834.
[7] S. Viswanathan, C. E. Campbell and R. C. Cork, “Asymptomatic Undetected Mediastinal Mass: A Death during Ambulatory Anesthesia,” Journal of Clinical Anesthesiology, 1995, 7: 151-155.
[8] T. P. Keon, “Death on Induction of Anesthesia for Cervical Lymph Node Biopsy,” Anesthesiology, Vol. 55, No. 4, 1981, pp. 471-472.
[9] R. K. Sharma, L. Swain and N. Dave, “Anesthetic Management of a Patient with Malignant Mediastinal Mass,” Indian Journal of Anaesthesia, Vol. 47, 2003, pp. 205207.
[10] P. Slinger and C. Karsli, “Management of the Patient with a Large Anterior Mediastinal Mass: Recurring Myths,” Current Opinion in Anesthesiology, Vol. 20, No. 1, 2007, pp. 1-3.
[11] M. H. Goh, X. Y. Liu and Y. S. Goh, “Anterior Mediastinal Masses: An Anesthetic Challenge,” Anesthesia, Vol. 54, No. 7, 1999, pp. 670-682.
[12] M. J. Javid, M. Rahimi and A. Keshvari, “Dissociative Conscious Sedation an Alternative to General Anesthesia for Laparoscopic Peritoneal Dialysis Catheter Implantation: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine,” Peritoneal Dialysis International, Vol. 31, No. 3, 2011, pp. 308-314. doi:10.3747/pdi.2010.00110
[13] M. J. Javid, “Conscious Sedation with Subcutaneous Ketamine as an Alternative to Airway Regional Blocks,” 1st International Congress of Airway Management and Anesthesia in Head and Neck Surgery, Tehran, 20-22 May 2009, p. 131.
[14] M. J. Javid, “Subcutaneous Dissociative Conscious Sedation (sDCS) an Alternative Method for Airway Regional blocks: A New Approach,” BMC Anesthesiology, Vol. 11, 2011, p. 19.
[15] G. Kim, S. M. Green, T. K. Denmark and B. Krauss, “Ventilatory Response during Dissociative Sedation in Children: A Pilot Study,” Academic Emergency Medicine, Vol. 10, No. 2, 2003, pp. 140-145.
[16] M. G. Soliman, G. F. Brinale and G. Kuster, “Response to Hypercapnia under Ketamine Anesthesia,” Canadian Anesthetists’ Society Journal, Vol. 22, No. 4, 1975, pp. 486494.

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.