Zor entübasyonlarda farklı laringoskop tiplerinin etkinliklerinin karşılaştırılması
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Dosyalar
Tarih
2012
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Endotrakeal entübasyonun anestezi pratiğinde başlıca endikasyonu genel anestezi uygulanacak hastalarda havayolu açıklığının ve güvenliğinin sağlanmasıdır. Anesteziyolojide klinik pratiklere laringoskopun girmesinden beri bütün çabalar laringoskop "blade"nin şeklini mükemmel yapmaya yöneliktir. Bunun amacı laringeal yapıların, glottisin daha iyi görülmesini sağlayarak endotrakeal entübasyonun başarı oranını artırmaktır. Laringoskopi ve endotrakeal entübasyon, larinks ve trakeanın mekanik uyarımına bağlı refleks sempatik bir yanıt oluşturarak plazma katekolamin konsantrasyonlarında artış, taşikardi, hipertansiyon, aritmiler ve özellikle kalp rezervi kısıtlı hastalarda miyokardial iskemiye sebep olabilir. Biz yaptığımız bu çalışmada, zor entübasyon olabileceği mallampati testi ile tahmin edilen hastalarda, Macintosh ve Truview EVO2TM laringoskobu; glottik görüntü kalitesi, entübasyon başarısı, entübasyon süresi, ve iki laringoskopa entübasyon sonrası gelişen hemodinamik yanıt ve komplikasyon oranları yönünden karşılaştırmayı amaçladık. Çalışmaya 18?65 yaş arasında değişen "American Society of Anesthesiologists" sınıflaması I-II dereceye giren mallampatisi III-IV olan elektif cerrahi uygulanacak 50 hasta dahil edildi. Hastalar rastgele 25'erli iki gruba ayrıldı. Grup M; Macintosh "blade"li laringoskop ile entübasyon yapılan grup, Grup T; Truview EVO2TM laringoskop ile entübasyon yapılan grup. Entübasyon esnasında tespit edilen Cormack-Lehane skoru, entübasyon süresi, entübasyon başarısı, komplikasyonlar ve Hemodinamik parametreler;Perioperatif kalp atım hızı, sistolik arter basıncı, diyastolik arter basıncı, ortalama arter basıncı, periferik oksijen satürasyonu değerleri kaydedildi. Her iki grupta glottik görüntü kalitesi karşılaştırıldığında Grubu T'de 16 (%64) olguda Cormack-Lehane skoru derece III ve IV olarak görülürken, Grup M'de 17 (%68) olguda Cormack-Lehane skoru derece III ve IV 51 olarak görüldü. Entübasyon süreleri; Grup M'de 13 sn, Grup T'de ise 27,76 sn olarak bulundu. Grup T'deki olgularda entübasyon süresi Grup M'deki olgulara göre anlamlı derecede yüksek bulundu. Entübasyon girişimi esnasında Grup M'de 6 (%24) olguda diş ve yumuşak doku hasarı oluşurken Grup T'de ise 5 (%20) olguda diş ve yumuşak doku hasarı oluştu, istatistiksel olarak anlamlı fark bulunmadı. Grup T'deki olgulara, Grup M'deki olgulara göre istatistiksel olarak anlamlı derecede daha fazla kuvvet uygulandığı bulundu. Hemodinamik parametreler açısından iki grup arasında anlamlı fark bulunmadı. Zor entübasyon düşünülen olgularda, daha iyi orafaringeal ve glottik görüntü elde ediliyor olması ve başarılı entübasyon sağlaması özellikleri ile Truview EVO2TM laringoskobun, Macintosh "blade"li laringoskop'a üstünlük sağladığı, fakat entübasyon süresi yönünden ise, Macintosh "blade"li laringoskobun Truview EVO2TM laringoskoba üstünlük sağladığı, kanısına varıldı.Anahtar kelimeler:Endotrakeal entübasyon,Macintosh "blade" laringoskop,Video-laringoskop
Abstract
The principal indication of endotracheal entubation in practically anesthesia is, to provide the safety of airline of the patients under general anestesia while clinically practising anesthesiology, all the effort is for making the perfect shape of the blade. While we are trying to do that our aim is, having a best seen of the structure of larynx, glottis and redounding the success of endotracheal intubation laryngoscopy and endotracheal intubation causes the increase of catecolamine, tachycardia, hypertension, aritmia and myokardial ischemia especially on the patients with limited reserved heart diseases by forming a reflex, sympathetic response depends on mechanically stimulus of larynx and traachea. In that study, we aimed to compare the guality of view, the success of intubation, hemodynamıc responses and complication of macintosch and Trueview EVO2 TM laryngoscopes on the patients who could have diffucult intubation that we forecast by the mallampaty classification. We included 50 patients to our research between the ages of 18-65 and in the classification of American Society of Anesthesiologists 1-2 who has degree of 3-4 mallompaty score. The patients were divided into two groups randomly. The first group is group M: the group which is intubated by macintosch blade and the second group is group T: the group which is intubated with truview EVO 2 TM laryngoscope. All the parameters the Cormack-Lehane score which is evaluate by the intubation; preoperatively heart rate, systolic 53 arteriel pressure, diastolic arteriel pressure and mean arteriel pressure, peripheral oxygen saturation were recorded. When we compare the quality of wiews;in the group T on 16 patients (%64) we found the cormack-lehane score 3 and 4 and in the group M on 17 patients(%68) we found the cormack-lehane score 3 and 4.The intubation periods were 13 sec. in group M and 27,26 sec.in group T.The intubation time on group T was significally meaningfull by considering group M. While the intubation, 6 patients in group M had damaged of teeth and soft palate. By the way, in group T, 5 patients had the same damages and there was no statistically meaningful difference. we found that, there were much power applied on patients in group T than group M. There was no important difference in both groups about the hemodynamically parameters. As a result: we can say that on the cases of diffucult intubation, truview EVO2 TM laryngoscope is much beter about having a best view of glottis and having a successful intubaton than macintosch. But in added to that; group M is much beter than group T about the period of time by intubating the patients.Keywords: Endotracheal intubation, macintosch “blade”, laryngoscope, video laryngoscope
Abstract
The principal indication of endotracheal entubation in practically anesthesia is, to provide the safety of airline of the patients under general anestesia while clinically practising anesthesiology, all the effort is for making the perfect shape of the blade. While we are trying to do that our aim is, having a best seen of the structure of larynx, glottis and redounding the success of endotracheal intubation laryngoscopy and endotracheal intubation causes the increase of catecolamine, tachycardia, hypertension, aritmia and myokardial ischemia especially on the patients with limited reserved heart diseases by forming a reflex, sympathetic response depends on mechanically stimulus of larynx and traachea. In that study, we aimed to compare the guality of view, the success of intubation, hemodynamıc responses and complication of macintosch and Trueview EVO2 TM laryngoscopes on the patients who could have diffucult intubation that we forecast by the mallampaty classification. We included 50 patients to our research between the ages of 18-65 and in the classification of American Society of Anesthesiologists 1-2 who has degree of 3-4 mallompaty score. The patients were divided into two groups randomly. The first group is group M: the group which is intubated by macintosch blade and the second group is group T: the group which is intubated with truview EVO 2 TM laryngoscope. All the parameters the Cormack-Lehane score which is evaluate by the intubation; preoperatively heart rate, systolic 53 arteriel pressure, diastolic arteriel pressure and mean arteriel pressure, peripheral oxygen saturation were recorded. When we compare the quality of wiews;in the group T on 16 patients (%64) we found the cormack-lehane score 3 and 4 and in the group M on 17 patients(%68) we found the cormack-lehane score 3 and 4.The intubation periods were 13 sec. in group M and 27,26 sec.in group T.The intubation time on group T was significally meaningfull by considering group M. While the intubation, 6 patients in group M had damaged of teeth and soft palate. By the way, in group T, 5 patients had the same damages and there was no statistically meaningful difference. we found that, there were much power applied on patients in group T than group M. There was no important difference in both groups about the hemodynamically parameters. As a result: we can say that on the cases of diffucult intubation, truview EVO2 TM laryngoscope is much beter about having a best view of glottis and having a successful intubaton than macintosch. But in added to that; group M is much beter than group T about the period of time by intubating the patients.Keywords: Endotracheal intubation, macintosch “blade”, laryngoscope, video laryngoscope
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Endotrakeal Entübasyon, Macintosh “blade” Laringoskop, Video-Laringoskop, Endotracheal Intubation, Macintosch “blade”, Laryngoscope, Video Laryngoscope
