Hasil untuk "Anesthesiology"

S. Rafieian, R. Ershadi, Hesam Amini et al.

Abstract Introduction Lung resection surgeries, including lobectomy and pneumonectomy, are cornerstone treatments for lung cancer and other severe pulmonary conditions. Despite their therapeutic benefits, these procedures can compromise cardiopulmonary function, potentially increasing right ventricular (RV) workload due to reduced pulmonary vascular capacity. Such changes may precipitate RV dysfunction, even in patients with normal preoperative cardiac profiles, contributing to postoperative morbidity like dyspnea and arrhythmias. While pulmonary function tests are standard for preoperative risk assessment, cardiac impacts—particularly on the RV—remain insufficiently characterized. This study employs Equilibrium radionuclide ventriculography (ERNV) scanning, a precise radionuclide ventriculography technique, to evaluate biventricular systolic and diastolic changes post-resection, supplemented by echocardiography to measure Right Ventricular Systolic Pressure (RVSP). Methods Twenty patients (mean age 43.8 ± 8.3 years, 10 females, 10 male) undergoing lobectomy (n = 15) or pneumonectomy (n = 5) from March 2021 to September 2022 were prospectively studied at a tertiary university hospital. Patients with preexisting coronary disease, hypertension, or abnormal pulmonary function (e.g., predicted postoperative FEV1 or DLCO < 60%) were excluded. Cardiac function was assessed preoperatively and two months postoperatively using ERNV scans to quantify right and left ventricular ejection fraction (EF), peak filling rate (PFR), and time to peak filling rate (TPFR). Transthoracic echocardiography measured RVSP concurrently. Statistical analyses included paired t-tests to compare pre- and postoperative indices, general linear models to assess surgery type effects, and regression analyses to correlate resection extent with RV changes. Results Lung resection significantly impaired cardiac performance. Right ventricular EF declined from 48.8 ± 2.6% to 43.7 ± 2.8% (p = 0.035) and left ventricular EF from 54.9 ± 2.7% to 51.3 ± 3.3% (p < 0.001). Diastolic function deteriorated, with the right PFR decreasing from 1.9 ± 0.2 to 1.7 ± 0.2 EDV/s (p < 0.001) and left PFR from 2.4 ± 0.1 to 2.2 ± 0.2 EDV/s (p = 0.001), while TPFR increased bilaterally (right: 151.8 ± 18.6 to 161.4 ± 17.6 ms, p < 0.001; left: 168.9 ± 11.7 to 176.1 ± 13.5 ms, p < 0.001). RVSP rose from 20 ± 2.6 to 24.9 ± 5.0 mmHg (p = 0.001). Pneumonectomy elicited greater reductions in RV indices than lobectomy, with resection extent strongly predicting RVEF decline (r = 0.7, p < 0.001). Conclusion Lung resection induces substantial biventricular systolic and diastolic dysfunction, with severity proportional to resection extent. These findings highlight the utility of ERNV scanning in detecting subtle cardiac changes and emphasize the importance of preoperative cardiac evaluation to anticipate and manage postoperative complications, particularly in extensive resections like pneumonectomy.

Si-Qing Cai, Yue Tian, Zi‑Xian Zhang et al.

Remifentanil is an ultrashort-acting opioid receptor agonist that has the greatest advantage in clinical analgesia but often induces hyperalgesia. The underlying mechanisms of remifentanil-induced hyperalgesia (RIH) remain unclear. Here, we report that exposure of remifentanil to rats induces an elevation of spontaneous neuronal activity, innoxious and noxious stimuli-evoked neuronal hyperactivities, and enhanced theta band local field potential (LFP) oscillations across the ventral posterolateral nucleus of the thalamus (VPL), primary somatosensory cortex (S1), insular cortex (IC), and anterior cingulate cortex (ACC) brain regions. Either chemogenetic inhibition of glutamatergic neurons in the S1 cortex, or blockade of the S1→ACC projection by chemogenetic and optogenetic approaches, attenuates the remifentanil-induced mechanical and thermal hyperalgesia in RIH model rats. Besides, electroacupuncture (EA) intervention at 2-Hz frequency alleviates the animals’ mechanical and thermal hyperalgesia in remifentanil-treated rats. Also, 2 Hz-EA treatment inhibits the remifentanil-induced enhancement of spontaneous neuronal activity, the innoxious and noxious stimuli-evoked hyperactivities, and the increase of theta band LFP oscillations in the VPL, S1, IC, and ACC cortexes. These results indicate that the sensitized neuronal activity and the heightened theta band brain rhythmical oscillations in the VPL, S1, IC, and ACC cortexes contributes to the development of RIH, while 2 Hz-EA treatment exerts its analgesic effects on the RIH through inhibiting the aberrant neuronal activities of pain-related thalamo-cortico-limbic circuits including VPL, S1, IC, and ACC brain regions. Our findings identify a cortical circuit mechanism underlying the pathogenesis of RIH, and present potential therapeutic targets for the treatment of RIH by EA. Summary: Sensitized neuronal activity and elevated theta rhythms in pain-related thalamo-cortico-limbic circuits contributes to RIH and the analgesic effects of 2 Hz-EA treatment on RIH.

Yu K, Gu Y, Yao Y et al.

Kaihua Yu,1,&ast; Yunfei Gu,2,&ast; Ying Yao,1 Jianchun Li,3 Suheng Chen,1 Hong Guo,4 Yulan Li,5 Jian Liu1,6 1The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, People’s Republic of China; 2Anesthesiology Department, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Center Hospital), Lanzhou, Gansu, People’s Republic of China; 3Department of Intensive Care Unit, Suzhou Science and Technology City Hospital, Nanjing, Jiangsu, People’s Republic of China; 4Department of Anesthesiology, Inner Mongolia Hospital of Peking University Cancer Hospital, Hohhot, Inner Mongolia, People’s Republic of China; 5Department of Anesthesiology, First Hospital of Lanzhou University, Lanzhou, Gansu, People’s Republic of China; 6Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Center Hospital), Lanzhou, Gansu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian Liu; Yulan Li, Email medecinliujian@163.com; liyul@lzu.edu.cnBackground: Oxygen supplementation is essential for patients with a multitude of diseases but can cause severe hyperoxia-induced lung injury (HLI), necessitating the identification of therapeutic targets to improve clinical outcomes. Cuproptosis, a novel copper-dependent form of cell death characterized by proteotoxic stress resulting from lipoylated protein aggregation and loss of iron-sulfur cluster proteins, is distinct from other forms of cell death. However, the role of cuproptosis in HLI remains unclear.Methods: We established an HLI model in MLE-12 cells and C57BL/6 mice to investigate the involvement of cuproptosis in hyperoxia-induced toxicity.Results: We observed a time-dependent increase in the cuproptosis-related gene Fdx1 under hyperoxia. Moreover, hyperoxia activated the membrane-associated copper transporter SLC31A1 and significantly elevated copper levels in MLE-12 cells, as well as in the serum and lung tissue of C57BL/6 mice. Further analysis revealed that hyperoxia significantly altered the expression of cuproptosis-related genes without affecting DLAT levels, but significantly increased lipoylated-DLAT levels. ELISA, CCK-8 assays, HE staining, lung wet-to-dry weight ratio, and bronchoalveolar lavage fluid analysis demonstrated that treatment with the cuproptosis inhibitor TTM reduced pro-inflammatory cytokines (TNF-α and IL-1β) and alleviated hyperoxia-induced injury in both MLE-12 cells and C57BL/6 mice.Conclusion: Our study identifies the involvement of cuproptosis in HLI, providing new insights into the pathogenesis of hyperoxic lung injury and potential therapeutic strategies.Keywords: hyperoxia, lung injury, hyperoxia-induced lung injury, cuproptosis, copper, FDX1

Mohammad Alomari, Breah Paciotti, Pankaj Garg et al.

Abstract Mitral and aortic annular calcification is an age-related degenerative process that can result in severe mitral and/or aortic stenosis and/or regurgitation. Annular calcification not only increases the surgical complexity but also increases the risk of complications. In this case report, we present the innovative use of the Sonopet ultrasonic surgical aspirator for aortic and mitral annular decalcification in a patient with hypertrophic obstructive cardiomyopathy, mild aortic stenosis and moderate mitral regurgitation in the presence of mitral annular calcification (MAC) and aorto-mitral curtain calcification.

Zhen-zhen Tu, Lin Bai, Xiao-ke Dai et al.

Abstract Background Pediatric patients undergoing liver transplantation are particularly susceptible to complications arising from intraoperative fluid management strategies. Conventional liberal fluid administration has been challenged due to its association with increased perioperative morbidity. This study aimed to assess the impact of intraoperative high-volume fluid therapy on pediatric patients who are undergoing living donor liver transplantation (LDLT). Methods Conducted at the Children’s Hospital of Chongqing Medical University from March 2018 to April 2021, this retrospective study involved 90 pediatric patients divided into high-volume and non-high-volume fluid administration groups based on the 80th percentile of fluid administered. We collected the perioperative parameters and postoperative information of two groups. Multivariable logistic regression was utilized to assess the association between estimated blood loss (EBL) and high-volume FA. Kaplan-Meier survival analysis was used to compare patient survival after pediatric LDLT. Results Patients in the high-volume FA group received a higher EBL and longer length of stay than that in the non-high-volume FA group. Multivariate logistic regression analysis indicated that hours of maintenance fluids and fresh frozen plasma were significantly associated risk factors for the occurrence of EBL during pediatric LDLT. In addition, survival analysis showed no significant differences in one-year mortality between the groups. Conclusions High-volume fluid administration during LDLT is linked with poorer intraoperative and postoperative outcomes among pediatric patients. These findings underscore the need for more conservative fluid management strategies in pediatric liver transplantations to enhance recovery and reduce complications.

Congqi Liu, Congqi Liu, Congqi Liu et al.

BackgroundMental health challenges are encountered by frail older adults as the population ages. The extant literature is scant regarding the correlation between depressive symptoms and social participation among frail older adults.MethodsThis study is based on an analysis of data from China Health and Retirement Longitudinal Study (CHARLS) participants aged 60 and older who are frail. A frailty index (FI) was developed for the purpose of assessing the frailty level of the participants. Additionally, latent class analysis (LCA) was employed to classify the participants’ social engagement patterns in 2015 and 2018. The study used ordered logistic regression to examine the relationship between social participation type and depressive symptoms. We also used Latent Transition Analysis (LTA) methods to explore the impact of changes in social activity types on depressive symptoms after three years of follow-up in 2018. In addition, the response surface analysis (RSM) investigation explored the relationship among FI, depression, and social participation.ResultsA total of 4,384 participants completed the baseline survey; three years later, 3,483 were included in the follow-up cohort. The baseline survey indicates that female older adults in rural areas who are single, have lower incomes, shorter sleep durations, and lighter weights exhibited more severe depressive symptoms. Social participation patterns were categorized into five subgroups by LCA. The findings indicate that individuals classified as “board game enthusiasts” (OR, 0.62; 95% CI, 0.47-0.82) and those as “extensive social interaction” (OR,0.67; 95% CI, 0.49-0.90) have a significantly lower likelihood of developing depressive symptoms compared to the “socially isolated” group. We also discovered that “socially isolated” baseline participants who transitioned to the “helpful individual” group after three years had significantly greater depressed symptoms (OR, 1.56; 95% CI, 1.00-2.44). More social activity types and less FI are linked to lower depression in our study.ConclusionThe results of the study emphasize the importance of social participation patterns and the number of social participation types in relation to the severity of depression among frail older adults individuals. This study’s findings may provide important insights for addressing depressive symptoms in frail older adults person.

Canan Atalay, Osman Nuri Keleş, Mehmet Aydin et al.

Objective: The blood-brain barrier is an electromagnetic mechanism on a neurophysical basis. In this study, we compared the X-Ray device, which is similar to the blood-brain barrier in many ways. Material and Methods: We collected brain samples from deep temporal cortex sections of ten rats, stained them via the glial fibrillary acidic protein (GFAP) technique, visualized the architectural structures of the blood-brain barriers, and compared them with X-ray devices. Results: With the arterioles forming the tube blood-brain barrier in the X-ray device, the anode-cathode that provides the electric current and determines the direction of the current flow corresponds to the astrocytes surrounding the anode-cathode vessel, the cooling system to the cerebrospinal fluid circulating the vessel, and the electrons emitted from the cathode to the particles flowing in the vessel. Conclusion: With the architecture presented by the blood-brain barrier, we envision it functioning as an X-Ray and optical reader that display objects in passenger baggage and direct them according to barcode numbers.

Despina Giakomidi, Mark F. Bird, David G. Lambert

There is a controversial narrative in the anaesthetic literature suggesting that anaesthetic technique (including opioids) may be detrimental to survival after tumour resection. The initial observations were retrospective. Several prospective studies are ongoing; one in breast cancer has reported no adverse outcome. The evidence for an effect of opioids stems from three pieces of information: (1) opioids depress the immune system, (2) opioids potentially promote angiogenesis, and (3) opioids potentially support tumour growth. Although the evidence for (2)/(3) is unclear, combinations of these effects are beneficial to tumours and potentially promote metastatic reseeding. Accepted wisdom suggests that opioid effects are driven by opioid receptor activation but the presence of opioid receptors on immune cells for example is unlikely. Immune cells, vascular endothelium and a range of tumour cells express Toll-like receptor 4 (TLR4) receptors (for Gram-negative bacterial wall components), and there is growing evidence for opioids interacting with this alternative receptor; and for some there is paradoxical naloxone sensitivity. Is the focus on opioid receptors and cancer the wrong target? TLR4 receptor activation produces immune activation, stimulates angiogenesis, and supports tumour survival. We know that some opioids are more immune suppressive than others (there is no such comparative information for angiogenesis and tumour survival); this may correlate with TLR4 activation. If there are clusters of opioids that have more opioid than TLR4 profiles and vice versa, this may influence outcome. If this is the case, then evidence-based advice could be given for perioperative use in the oncology–anaesthesia setting.

Qiang Shu, Dongpi Wang, Jinjin Huang et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread widely and persistently over 100 countries. New challenges have occurred in the perioperative management of airway and anesthesia in children diagnosed with SARS-CoV-2 infection. According to current publications and to our own experiences in anesthesia management for cases with SARS-CoV-2 suspected, we reviewed concerns about the perioperative prevention of SARS-CoV-2 to medical staff and the anesthesia strategy to the patient.

Mie Kajiwara, Risako Kato, Yoshiyuki Oi et al.

Little is known about how propofol modulates the spike firing correlation between excitatory and inhibitory cortical neurons in vivo. We performed extracellular unit recordings from rat insular cortical neurons, and classified neurons with high spontaneous firing frequency, bursting, and short spike width as high frequency with bursting neurons (HFB; pseudo fast-spiking GABAergic neurons) and other neurons with low spontaneous firing frequency and no bursting were classified as non-HFB. Intravenous administration of propofol (12 mg/kg) from the caudal vein reduced the firing frequency of HFB, whereas propofol initially increased (within 30 s) and then decreased the firing frequency of non-HFB. Both HFB and non-HFB spontaneous action potential discharge was depressed by propofol with a greater depression seen for HFB. Cross-correlograms and auto-correlograms demonstrated propofol-induced increases in the ratio of the peak, which were mostly observed around 0–10 ms divided to baseline amplitude. The analysis of interspike intervals showed a decrease in spike firing at 20–100 Hz and a relative increase at 8–15 Hz. These results suggest that propofol induces a larger suppression of firing frequency in HFB and an enhancement of synchronized neural activities in the α frequency band in the cerebral cortex (192 words). Keywords: General anesthetics, Insular cortex, Synchronization, GABAergic neuron, Awake

Abhijit Nair, Sandeep Diwan

Mohammed Rizwan, Kanil R Kumar, Christopher Dass et al.

Martins MJ, Martins CPMO, Castro-Alves LJ et al.

Marcelo J Martins,1 Caroline Paiva Matos Oliveira Martins,2 Lucas J Castro-Alves,3 Gabriel Nascimento Jesus,4 Guilherme Oliveira Campos,5 Breno Barbosa Cerqueira Sacramento,4 Leonardo Ferrari Borges,6 Carlos Augusto Bastos Mello,6 Rodrigo Leal Alves,5 Norma Sueli Pinheiro M&oacute;dolo7 1Department of Anesthesiology, S&atilde;o Paulo State University (UNESP), S&atilde;o Paulo, Brazil; 2Department of Anesthesiology at Federal University of Bahia, Bahia, Brazil; 3Department of Anesthesiology, Santo Antonio Hospital, Salvador, Bahia, Brazil; 4Department of Anesthesia, Bahia University of Medicine and Public Health, Bahia, Brazil, 5Department of Anesthesiology, Hospital Sao Rafael, Salvador, Bahia, Brazil; 6Department of Surgery, Hospital Tereza de Lisieux, Salvador, Bahia, Brazil; 7Department of Anaesthesiology, S&atilde;o Paulo State University (UNESP), Botucatu, Brazil Purpose: Obesity has been considered as a major public health problem in developed countries for which bariatric surgery has become an important treatment strategy. Postoperative pain, however, is a frequent problem in postoperative management. Pregabalin blocks the development of hyperalgesia and central pain sensitization. The objective of this randomized, placebo-controlled, double-blinded trial was to evaluate the effect of a single dose of preoperative pregabalin vs placebo on the quality of postoperative recovery in patients undergoing bariatric surgery.Patients and methods: A total of 70 patients undergoing abdominal gastroplasty were randomly assigned to receive oral pregabalin (75 mg) or an identical placebo 1 hour before surgery. The primary outcome was Quality of Recovery-40 (QoR-40) score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. P&lt;0.05 was considered to indicate statistical significance.Results: In all, 60 of the 70 patients completed the study. The mean (SD) global recovery scores (QoR-40) 24 hours after surgery in the pregabalin and control groups were 183.7 (9) and 182.1 (12), respectively (mean difference=1.6, 95% CI &ndash;7.36 to 4.2, P=0.59). There was no significant difference in the total opioid consumption in the 24 hours following surgery between the two groups (pregabalin vs control=0.47&times;0.2; mean difference=0.26, 95% CI &minus;0.24 to 0.77, P=0.3). There were no significant differences in nausea, vomiting, or time to postanesthesia care unit discharge between the two groups.Conclusion: In patients who underwent bariatric surgery, a single preoperative dose of pregabalin (75 mg) did not improve pain relief, quality of postoperative recovery, or reduction in opioid consumption.Clinical trial registration:&nbsp;http://www.ensaiosclinicos.gov.br&nbsp;(identifier: RBR-2g89x8). Keywords: gastroplasty, hyperalgesia, opioid

Glen Atlas, Mina Mosaad, Faraz Chaudhry et al.

Maria Louise Fabritius, Anja Geisler, Pernille Lykke Petersen et al.

Abstract Background It has been argued that postoperative pain treatment should be “procedure-specific”, since different analgesics may have specific effects dependent on the surgical procedure. The aim of the present subgroup analysis was to compare the beneficial and harmful effects of perioperative gabapentin treatment in different surgical procedures. Methods Relevant databases were searched for randomized clinical trials (RCTs) comparing gabapentin versus placebo. Two authors independently screened titles and abstracts, extracted data and assessed risk of bias. The primary outcomes were differences in 24-h morphine consumption, and serious adverse events (SAE) between surgical procedures. These subgroup analyses were predefined in a PRISMA compliant systematic review registered at PROSPERO (ID: CRD42013006538). It was predefined that conclusions should primarily be based on trials classified as overall low risk of bias. Results Seventy-four RCTs with 5645 patients were included, assessing benefit and harm in cholecystectomy, hysterectomy, mastectomy, and arthroplasty surgery, spinal surgery, and thoracic surgery. Only eight of 74 trials were classified as overall low risk of bias limiting our ability to conclude on the estimates in most meta-analyses. The differences between surgical procedures in these trials were not statistically significant when tested for subgroup differences. Fifteen trials with 1377 patients reported a total of 59 SAEs, most of which were observed in the thoracic surgery group. Conclusion Both beneficial and harmful effects in these subgroup analyses were influenced by bias and insufficient data, limiting conclusions. With these limitations, we could not adequately test for differences in beneficial or harmful outcomes between six surgical subgroups undergoing perioperative gabapentin treatment.

Sumitra Ganesh Bakshi, Jigeeshu Vasishtha Divatia, Sadhana Kannan et al.

Background and Aims: Work-related stress is common among medical caregivers and concerns all perioperative care providers. Although anesthesiologists are known to experience stress, there are limited Indian data addressing this issue. This survey was conducted among Indian anesthesiologists to determine their awareness about work stress and views regarding prevention programs. Material and Methods: A survey questionnaire was distributed to delegates visiting the exhibits at the national anesthesiology conference in 2011. The questionnaire had ten questions on the work pattern, five on work-related stress, nine on opinion regarding the need and willingness to participate in stress-related programs. Results: There were 1178 responders. Forty-three percent were faculty in medical institutions, 26% were residents and 25% were in free-lance practice. Ninety-one percent of participants rated their stress as moderate-extreme. There was a significant correlation between the amount of stress and working for more than 8 h (P < 0.001), handling high risk patients (P = 0.002), working on weekends (P = 0.002), and carrying work back home (P < 0.001). Forty-one percent of respondents were very satisfied professionally. Seventy-six percent of doctors agreed that the questionnaire had made them think about work stress. Eighty-four percent of participants felt the need for stress management programs and 69% expressed their willingness to participate in the same. Conclusion: The majority of participants rated their stress as moderate-extreme and was higher in anesthesiologists working long hours, over the weekend and those handling high-risk patients. A majority of participants felt the survey made them think about work-related stress and expressed their willingness to participate in stress management programs.

Anna Ghizzani, Teresa Pozzi, Gloria Bocci

Fibromyalgia, characterized by widespread musculoskeletal pain, negatively impacts sexuality by provoking dispareunia, and loss of desire and of dyadic gratification. Chronic pain syndromes tend to associate and FM women have a higher probability to develop vulvodynia than women not affected by fibromyalgia. Vulvodynia, characterized by burning pain that interferes with sexual penetration, is classified as Genitopelvic/Penetration Disorders in DSM 5. The association between Fibromyalgia and vulvodynia is difficult to recognize because patients tend to attribute all symptoms to disease spread and not think that dyspareunia may have different origins. To establish the necessary criteria for the differential diagnosis between the two syndromes, we evaluated the characteristics of dyspareunia and sexual behavior of fibromyalgia patients versus vulvodynia patients and we found significant differences on the onset of burning pain, orgasmic capability, and sexual frequency.

Tanvir Samra, Vikas Saini, Tenzin Kyizom

Thomas M Hemmerling, Shantale Cyr, Nora Terrasini

Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

Javid Mihan J

<p>Abstract</p> <p>Background</p> <p>Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation. Airway regional blocks which are commonly used to facilitate awake intubation are sometimes impossible or forbidden. On the other hand deep sedation could be life threatening in the case of compromised airway.</p> <p>The aim of this study is evaluating "Subcutaneous Dissociative Conscious Sedation" (sDCS) as an alternative method to airway regional blocks for awake intubation.</p> <p>Methods</p> <p>In this prospective, non-randomized study, 30 patients with predicted difficult airway (laryngeal tumors), who were scheduled for direct laryngoscopic biopsy (DLB), underwent "Subcutaneous Dissociative Conscious Sedation" (sDCS) exerted by intravenous fentanyl 3-4ug/kg and subcutaneous ketamine 0.6-0.7 mg/kg. The tongue and pharynx were anesthetized with lidocaine spray (4%<b>)</b>. 10 minutes after a subcutaneous injection of ketamine direct laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered if the patient wasn't cooperative enough for laryngoscopy.</p> <p>Patients were evaluated for hemodynamic stability (heart rate and blood pressure), oxygen saturation (Spo₂), patient cooperation (obedient to open the mouth for laryngoscopy and the number of tries for laryngoscopy), patient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration before laryngoscopy).</p> <p>Results</p> <p>Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and then laryngoscopy was performed successfully on the second try. All patients were cooperative enough during laryngoscopy. Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo₂< 90%) didn't occur in any patient.</p> <p>Conclusions</p> <p>Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable and safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication rate for regional airway blocks.</p> <p>Registration ID in IRCT</p> <p>IRCT201012075333N1</p>