Tiroid cerrahisi uygulanan hastalarda, postoperatif vokal korddeğerlendirilmesinde C-mac® D blade videolaringoskop ile macintoshlaringoskopun karşılaştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
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Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda elektif şartlarda nöromonitorizasyon kullanılarak tiroid operasyonu yapılan hastalarda, postoperatif vokal kord hareketlerini değerlendirmede C-MAC® D Blade videolaringoskop ve Macintoch laringoskop (ML) kullanımının hemodinamik parametreler üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Mevcut araştırma için İnönü Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından 2022/115 numaralı protokol koduile onay alındı. Mevcut araştırmaya 105 tiroidektomi cerrahisi geçirecek hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, boy, kilo ve American Society of Anesthesiologists (ASA) skoru kaydedildi. Hastalar C-MAC® D Blade videolaringoskop ve Macintoch laringoskop kullanımına göre 2 gruba ayrıldı. C-MAC® D Blade videolaringoskop ile entübasyon planlanan hastalar Grup I, Macintoch laringoskop ile entübasyon planlanan hastalar Grup II olarak adlandırıldı. Tüm hastalara rutin anestezi monitörizasyonuna ek nöromusküler ve Bispektral İndeks (BİS) monitörizasyon yapıldı. Hastalara 1 mg/kg % 2 lidokain, 2 µg/kg fentanil, 2 mg/kg propofol 0,6 mg/kg rokuronyum ile indüksiyon yapılarak TOF değeri 0 olduğunda Grup I hastaları C-MAC videolaringoskop ile Grup II hastalar Macintoch laringoskop ile entübe edildi. Entübasyon esnasında vokal kordların görünümü Cormack ve Lehane Sınıflaması'na göre yapıldı. Entübasyon esnasında BURP (arkaya, yukarıya ve sağa bası) manevrası kullanımı kaydedildi. Cerrahi süresince hastalarınbazal (T0), İndüksiyon sonrası (T1), entübasyon sonrası (T2), entübasyondan 5dk sonra (T3), cerrahi bitimi (T4), ekstübasyon sonrası (T5), kalp atım hızı (KAH), ortalama arteriyal basınç (OAB), sistolik arteriyal basınç (SAB ) ve periferik oksijen saturasyonu (SpO2) ve BİS değerleri kaydedildi. Cerrahi sonrası hastalar ekstübe edildi. Grup I hastalar videolaringoskop, Grup II Macintosh bleyd kullanılarak vokal kord muayenesi; vokal kord hareketi altı skalalı değerlendirme tablosuna göre yapıldı, ek propofol ihtiyacı ve BURP görülme oranı kaydedildi. Bulgular: Grupların demografik verileri benzer olup (p>0.05). Grup I ve II de ekstübasyon sonrası kaydedilen değerlere göre ve muayene sonrası KAH ve SAB ortalamasındaki artış istatistiksel olarak anlamlı olduğu görüldü. Grup I'de ekstübasyon sonrası ve muayene sonrası kaydedilen değerlere göre DAB, OAB ortalamasındaki artış, istatistiksel olarak anlamlı bir değişim olmayıp, Grup II ise artış istatistiksel olarak anlamlıydı. Gruplar arasında VCS skorları açısından istatistiksel olarak anlamlı bir farklılık bulunmamaktadır (p>0.05). Her iki grupta ek propofol ihtiyacı istatistiksel olarak benzer olup (p>0.05), Grup II'de BURP görülme oranı Grup I'den daha yüksek olmakla birlikte bu farklılık istatistiksel olarak anlamlı bulunmamıştır (p>0.05). Sonuç: Bu çalışma tiroidektomi sonrası sıklıkla karşılaşılan rekürren laringeal sinir hasarının varlığında klinik değerlendirme için altın standart laringoskopi yanında videolaringoskopların kullanım kolaylığı sağladığı ve daha etkin bir değerlendirme sağladığı için direk laringoskopiye alternatif olacağı sonucuna varılmıştır. Anahtar Kelimeler: Endotrakeal entübasyon, Nöromonitorizasyon tüpü, C-MAC Video laringoskop, Macintosh laringoskop, Hemodinamik etki
Objective: In our study, we aimed to compare the effects of using C-MAC® D Blade videoringoscope and Macintoch laryngoscope (ML) on hemodynamic parameters in the evaluation of postoperative vocal cord movements in patients who underwent thyroid surgery using neuromonitoring under elective conditions. Materials and Methods: The current study was approved by the Inonu University Clinical Research Ethics Committee with the protocol code 2022/115. 105 patients who will undergo thyroidectomy surgery were included in the current study. Age, gender, height, weight and American Society of Anesthesiologists (ASA) scores of the patients were recorded. The patients were divided into 2 groups according to the use of C-MAC® D Blade videoingoscope and Macintoch laryngoscope. The patients who were planned for intubation with the C-MAC® D Blade videoringoscope were named Group I, and the patients who were planned for intubation with the Macintoch laryngoscope were named Group II. Neuromuscular and Bispectral Index (BIS) monitoring was performed in addition to routine anesthesia monitoring in all patients. Patients were intubated with 1 mg/kg 2% lidocaine, 2 µg/kg fentanyl, 2 mg/kg propofol 0.6 mg/kg rocuronium, and when the TOF value was 0, Group I patients were intubated with a C-MAC videoryngoscope, and Group II patients were intubated with a Macintoch laryngoscope. The appearance of the vocal cords during intubation was made according to the Cormack and Lehane Classification. The use of the BURP (backward, upward and right compression) maneuver during intubation was recorded. During the surgery, patients' baseline (T0), post-induction (T1), post-intubation (T2), 5 minutes after intubation (T3), the end of surgery (T4), post-extubation (T5), heart rate (HR), mean arterial pressure ( MAP), systolic arterial pressure (SAB) and peripheral oxygen saturation (SpO2) and BIS values were recorded. After surgery, the patients were extubated. Group I patients had vocal cord examination using a videoringoscope, Group II a Macintosh blade; Vocal cord movement was performed according to a six-scale evaluation table, additional propofol requirement and BURP incidence were recorded. Results: Demographic data of the groups were similar (p>0.05). In Groups I and II, the increase in the mean HR and SAP was statistically significant compared to the values recorded after extubation and after examination. According to the values recorded after extubation and after examination in Group I, the increase in the mean DAP and MAP was not a statistically significant change, while the increase was statistically significant in Group II. There was no statistically significant difference between the groups in terms of VCS scores (p>0.05). The need for additional propofol in both groups was statistically similar (p>0.05), although the incidence of BURP in Group II was higher than in Group I, this difference was not statistically significant (p>0.05). Conclusion: In this study, it was concluded that in the presence of recurrent laryngeal nerve damage, which is frequently encountered after thyroidectomy, in addition to the gold standard laryngoscopy for clinical evaluation, videosyngoscopes will be an alternative to direct laryngoscopy as they provide ease of use and provide a more effective evaluation Keywords: Endotracheal intubation, neuromonitorisation tube, C-MAC Video Laryngoscope, Macintosh laryngoscopy, Hemodynamic effect
Objective: In our study, we aimed to compare the effects of using C-MAC® D Blade videoringoscope and Macintoch laryngoscope (ML) on hemodynamic parameters in the evaluation of postoperative vocal cord movements in patients who underwent thyroid surgery using neuromonitoring under elective conditions. Materials and Methods: The current study was approved by the Inonu University Clinical Research Ethics Committee with the protocol code 2022/115. 105 patients who will undergo thyroidectomy surgery were included in the current study. Age, gender, height, weight and American Society of Anesthesiologists (ASA) scores of the patients were recorded. The patients were divided into 2 groups according to the use of C-MAC® D Blade videoingoscope and Macintoch laryngoscope. The patients who were planned for intubation with the C-MAC® D Blade videoringoscope were named Group I, and the patients who were planned for intubation with the Macintoch laryngoscope were named Group II. Neuromuscular and Bispectral Index (BIS) monitoring was performed in addition to routine anesthesia monitoring in all patients. Patients were intubated with 1 mg/kg 2% lidocaine, 2 µg/kg fentanyl, 2 mg/kg propofol 0.6 mg/kg rocuronium, and when the TOF value was 0, Group I patients were intubated with a C-MAC videoryngoscope, and Group II patients were intubated with a Macintoch laryngoscope. The appearance of the vocal cords during intubation was made according to the Cormack and Lehane Classification. The use of the BURP (backward, upward and right compression) maneuver during intubation was recorded. During the surgery, patients' baseline (T0), post-induction (T1), post-intubation (T2), 5 minutes after intubation (T3), the end of surgery (T4), post-extubation (T5), heart rate (HR), mean arterial pressure ( MAP), systolic arterial pressure (SAB) and peripheral oxygen saturation (SpO2) and BIS values were recorded. After surgery, the patients were extubated. Group I patients had vocal cord examination using a videoringoscope, Group II a Macintosh blade; Vocal cord movement was performed according to a six-scale evaluation table, additional propofol requirement and BURP incidence were recorded. Results: Demographic data of the groups were similar (p>0.05). In Groups I and II, the increase in the mean HR and SAP was statistically significant compared to the values recorded after extubation and after examination. According to the values recorded after extubation and after examination in Group I, the increase in the mean DAP and MAP was not a statistically significant change, while the increase was statistically significant in Group II. There was no statistically significant difference between the groups in terms of VCS scores (p>0.05). The need for additional propofol in both groups was statistically similar (p>0.05), although the incidence of BURP in Group II was higher than in Group I, this difference was not statistically significant (p>0.05). Conclusion: In this study, it was concluded that in the presence of recurrent laryngeal nerve damage, which is frequently encountered after thyroidectomy, in addition to the gold standard laryngoscopy for clinical evaluation, videosyngoscopes will be an alternative to direct laryngoscopy as they provide ease of use and provide a more effective evaluation Keywords: Endotracheal intubation, neuromonitorisation tube, C-MAC Video Laryngoscope, Macintosh laryngoscopy, Hemodynamic effect
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
