Bariyatrik cerrahi planlanan morbid obez olgularda entübasyon: Macintosh laringoskop ve mcgrath® videolaringoskopun karşılaştırılması
Küçük Resim Yok
Tarih
2018
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Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET BARİYATRİK CERRAHİ PLANLANAN MORBİD OBEZ OLGULARDA ENTÜBASYON: MACINTOSH LARİNGOSKOP VE MC-GRATH® VİDEOLARİNGOSKOPUN KARŞILAŞTIRILMASI Amaç: Bariyatrik cerrahi uygulanan morbid obez hastaların entübasyon işleminde; Macintosh laringoskop ve McGrath videolaringoskopun entübasyon süresi, hemodinamik yanıt ve entübasyona bağlı komplikasyonlar açısından karşılaştırılması amaçlandı. Materyal ve Metot: Bariyatrik cerrahi yapılması planlanan 18-65 yaş arası 70 olgu çalışmaya dâhil edildi. Macintosh laringoskop; Macintosh (n=35), McGrath videolaringoskop; McGrath (n=35) olmak üzere 2 gruba ayrıldı. Mallampati skoru, baş pozisyon değişimi, intergingival ve tiromental mesafeler kaydedildi. Hastaların indüksiyon ve entübasyon öncesi, entübasyon sonrası 1., 2., 3. ve 5. dakikalarda; sistolik, diastolik ve ortalama arter basınçları, kalp atım hızı, periferik oksijen saturasyonu, solunum sayısı, end-tidal karbondioksit değerleri kaydedildi. Tüm olgularda Cormack-Lehane skoru, glottik derecesi, entübasyon süresi, laringeal bası uygulanması, Magill forseps kullanımı, entübasyon sonrası hemodinamik yanıtlar, opioid kullanımı ve entübasyona bağlı komplikasyonlar kaydedildi. Bulgular: Macintosh ve McGrath grupları; cinsiyet, yaş, kilo, boy, vücut kitle indeksi, komorbidite, operasyon tipi, anestezi ve operasyon süreleri açısından birbirine benzerdi. McGrath'ta Mallampati, Cormack Lehanne skorları ve glottik derece anlamlı olarak yüksekti. Tiromental ve intergingival mesafeler, baş pozisyon değişikliği ve magill forseps kullanımı açısından iki grup birbirine benzerdi. Mc-Grath'ta; entübasyon süresi anlamlı olarak daha kısa, tek seferde girişim başarısı anlamlı olarak daha yüksek ve eksternal larengeal bası ihtiyacı anlamlı olarak daha az idi. Başarısız girişim sayısı Macintosh'ta anlamlı olarak yüksek idi. İki grup; entübasyon sonrası opioid kullanımı, entübasyona bağlı komplikasyonlar ve hemodinamik yanıtlar açısından benzerdi. Sonuç: Zor entübasyon riski yüksek olan morbid obez hastalarda; entübasyon süresi daha kısa, tek seferde girişim başarısı yüksek ve daha az laringeal bası ihtiyacı olan McGrath videolaringoskop kullanılmasının zor havayolu yönetiminde faydalı olacağı düşünüldü. Anahtar Kelimeler: Morbid Obezite, Zor Havayolu, Zor Entübasyon, Macintosh Laringoskop, McGrath Videolaringoskop.
ABSTRACT INTUBATION IN MORBIDLY OBESE PATIENTS UNDERGOING BARIATRIC SURGERY: A COMPARISON OF MACINTOSH LARYNGOSCOPE AND MCGRATH® VIDEOLARYNGOSCOPE Aim: To compare Macintosh laryngoscope and McGrath videolaryngoscope in respect to duration of intubation, haemodynamic response, and complications related intubation in intubation of morbidly obese patients undergoing bariatric surgery; Materials and Methods: Seventy patients with aged 18-65 years old scheduled for bariatric surgery were included in this study. The patients were divided randomly into 2 groups; Macintosh laryngoscope; Macintosh (n = 35), McGrath videolaryngoscope; McGrath (n = 35). Mallampati score, change of head position, intergingival and thyromental distances were recorded. Systolic, diastolic and mean arterial pressures, heart rate, peripheral oxygen saturation, respiratory rate, and end-tidal carbon dioxide values were recorded before anesthesia, after induction, at 1th, 2nd, 3rd and 5th minutes after intubation. Cormack-Lehane score, glottic grade, duration of intubation, laryngeal compression, use of Magill forceps, hemodynamic responses after intubation, use of opioid and complications related intubation were recorded in all cases. Results: The two groups were similar in respect to gender, age, weight, height, body mass index, comorbidity, type of operation, duration of anesthesia and operation. Mallampati score, Cormack Lehanne score and glottic degrees were significantly higher in McGrath. The two groups were similar in terms of thyromental and intergingival distances, change of head position and use of Magill forceps. McGrath significantly had a shorter duration of intubation, higher intervention success in one time and less need for external laryngeal compression. The number of failed intervention was significantly higher in Macintosh. The two groups were similar in respect to use of opioid after intubation, complications related intubation and hemodynamic responses. Conclusion: This study showed that McGrath videolaryngoscope, which has shorter duration of intubation, higher intervention success in one time and less need for external laryngeal compression, is useful for difficult airway management in morbidly obese patients with a high risk of difficult intubation. Keywords: Morbid Obesity, Difficult Airway, Difficult Intubation, Macintosh Laryngoscope, McGrath Videolaryngoscope.
ABSTRACT INTUBATION IN MORBIDLY OBESE PATIENTS UNDERGOING BARIATRIC SURGERY: A COMPARISON OF MACINTOSH LARYNGOSCOPE AND MCGRATH® VIDEOLARYNGOSCOPE Aim: To compare Macintosh laryngoscope and McGrath videolaryngoscope in respect to duration of intubation, haemodynamic response, and complications related intubation in intubation of morbidly obese patients undergoing bariatric surgery; Materials and Methods: Seventy patients with aged 18-65 years old scheduled for bariatric surgery were included in this study. The patients were divided randomly into 2 groups; Macintosh laryngoscope; Macintosh (n = 35), McGrath videolaryngoscope; McGrath (n = 35). Mallampati score, change of head position, intergingival and thyromental distances were recorded. Systolic, diastolic and mean arterial pressures, heart rate, peripheral oxygen saturation, respiratory rate, and end-tidal carbon dioxide values were recorded before anesthesia, after induction, at 1th, 2nd, 3rd and 5th minutes after intubation. Cormack-Lehane score, glottic grade, duration of intubation, laryngeal compression, use of Magill forceps, hemodynamic responses after intubation, use of opioid and complications related intubation were recorded in all cases. Results: The two groups were similar in respect to gender, age, weight, height, body mass index, comorbidity, type of operation, duration of anesthesia and operation. Mallampati score, Cormack Lehanne score and glottic degrees were significantly higher in McGrath. The two groups were similar in terms of thyromental and intergingival distances, change of head position and use of Magill forceps. McGrath significantly had a shorter duration of intubation, higher intervention success in one time and less need for external laryngeal compression. The number of failed intervention was significantly higher in Macintosh. The two groups were similar in respect to use of opioid after intubation, complications related intubation and hemodynamic responses. Conclusion: This study showed that McGrath videolaryngoscope, which has shorter duration of intubation, higher intervention success in one time and less need for external laryngeal compression, is useful for difficult airway management in morbidly obese patients with a high risk of difficult intubation. Keywords: Morbid Obesity, Difficult Airway, Difficult Intubation, Macintosh Laryngoscope, McGrath Videolaryngoscope.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
