Timpanomastoidektomilerde videolaringoskopi ile kas gevşeticisiz entübasyonun hemodinami ve entübasyon koşullarına etkisi
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Dosyalar
Tarih
2017
Yazarlar
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Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda timpanoplasti ve mastoidektomi cerrahisi geçirecek, propofol ve remifentanil ile kas gevşeticisiz entübasyon uyguladığımız olgularda; videolaringoskopla elde edilen endoskopik görüntü skorlarını, entübasyon başarısı ve süresini, entübasyon sonrası hemodinamik yanıt üzerine olan etkileri direkt laringoskopla karşılaştırmayı amaçladık. Gereç ve Yöntem: Elektif timpanoplasti ve masteidektomi cerrahisi planlanan 18-65 yaş arası, fiziksel durumu ASA I-II ve Mallampati skoru I-II olan toplam 63 olgu çalışma kapsamına alındı. Hastalar rastgele, zarf yöntemine göre 30'arlı iki gruba ayrıldı : Grup D; Direkt laringoskop ile entübasyon yapılacak grup. Grup V; Videolaringoskop ile entübasyon yapılacak grup. Operasyon odasına alındıktan sonra hastalara EKG, noninvaziv kan basıncı, SpO2 monitörizasyonu yapıldı. Yüz maskesi ile en az 3 dk %100 O2 ile preoksijenizasyon uygulandı. Anestezi indüksiyonu 1 mg/kg lidokain ve 3 μg/kg remifentanil 60 saniye surede verilerek 90 saniye beklenildi ve daha sonra propofol 2.5 mg/kg'dan 30 saniyede verildi. Anestezi %50 oksijen ve %50 azot protoksit içinde sevofluran ile idame ettirildi. Olguların anestezi indüksiyonu öncesi (bazal), indüksiyon sonrasında ve entübasyon sonrası 1. 3. 5. 10. ve 20. dakikalarda SAB, OAB, KAH ve SpO2 değerleri kaydedildi. Olguların entübasyon koşulları Helbo-Hansen Raulo entübasyon skorlama kriterlerine göre değerlendirildi. Cormack-Lehane ve Mallampati Skorları, entübasyon deneme sayıları, laringoskopi ve entübasyon zamanı kaydedildi. Entübasyona bağlı gelişen komplikasyonlar (oral mukozal kanama, özefagial entübasyon, desatürasyon) ve ekstübasyon sonrası ses kısıklığı, boğaz ağrısı varlığı not edildi. Bulgular: Çalışmaya 63 olgu alındı. Bir hasta zor havayolu gözlemlenmesi nedeniyle çalışma dışı bırakıldı. 62 olgu değerlendirmeye alındı. Gruplar arası değerlendirmede KAH'da, Grup D ve Grup V arasında istatistiksel olarak anlamlı fark görülmedi. Grup D ve Grup V arasında SAB ve OAB'da entübasyon sonrası 1. 3. 5. 10. ve 20. dakikalarda istatistiksel olarak anlamlı fark görülmedi. Kan basıncı değerleri indüksiyon sonrası en fazla düşüş göstermiş fakat entübasyon sonrası artmış ancak bazal değeri hiç geçmemiştir. Entübasyon süresi açısından Grup D (22.19 sn) ile Grup V (29.19 sn) arasında istatistiksel olarak anlamlı farklılık vardı. Sonuç: Sonuç olarak; kas gevşeticisiz entübasyonda McGrath® MAC videolaringoskop Macintosh direkt laringoskop ile karşılaştırıldığında, daha iyi entübasyon koşulları oluştururken, trakeal entübasyona bağlı hemodinamik yanıtta benzer değişiklikler tespit edildi. Anahtar Kelimeler: Kas gevşeticisiz entübasyon, Laringoskopi, Hemodinamikler, Videolaringoskopi
Aim: In our study, we aimed to compare the effects of hemodynamic response after intubation with direct laryngoscopy that tympanoplasty and mastoidectomy undergoing surgery, endoscopic image scores obtained with videolaringoscopy in cases of intubation without muscle relaxant, which we have been using with propofol and remifentanil, the success and duration of intubation, Materials and Methods: Elective tympanoplasty and mastoidectomy surgeon planned to age between 18-65, a total of 63 subjects with ASA I-II and Mallampati score I-II were included in the study. Patients were randomly divided, according to the envelope method into two groups of 30: Group D; Group to be intubated with direct laryngoscope Group V; Group to be intubated with videolaryngoscope The patients were monitorised with ECG, noninvasive arterial pressure, SpO2 after they were taken to the operating room. Preoxygenation was performed with face mask for at least 3 minutes with 100 % O2. Anesthesia induction was given for 90 seconds with 1 mg / kg lidocaine and 3 μg / kg remifentanil for 60 seconds and then propofol was administered at 2.5 mg / kg for 30 seconds. Anesthesia was maintained with sevoflurane and 50% oxygen and 50% nitrous oxide. Systolic arterial pressure (SAP), mean arterial pressure (MAP), heart rate (HR) and SpO2 were recorded at baseline, after anesthesia induction and at 1, 3, 5, 10 and 20 minutes after intubation. The entubation conditions of the cases were evaluated according to the Helbo-Hansen Raulo intubation scoring criteria. Cormack-Lehane and Mallampati Scores, number of intubation attempts, laryngeal compression, intubation time were recorded. The incidence of complications due to intubation (oral mucozal bleeding, oesophageal intubation, desaturation), after extubation hoarseness and sore throat were recorded. Results: 63 cases were included in the study. One patient was excluded due to difficult airway observation. 62 cases were evaluated. There was no statistically significant difference between groups D and V in HR. There was no statistically significant difference between Group D and Group V in SAB and OAB after 1, 3, 5, 10 and 20 minutes after intubation. Blood pressure values showed the greatest decrease after induction but increased after intubation but no baseline value. There was a statistically significant difference between groups D (22.19 sec) and Group V (29.19 sec) with respect to the duration of intubation. Conclusion: As a result; When McGRATH® MAC videolaryngoscope compared to Macintosh direct laryngoscop in without muscle relaxant intubation, provide better intubation conditions, similar changes detected in hemodinamic response due to tracheal intubation. Key words: Intubation without muscle relaxant, Laryngoscopy, Hemodynamics, Videolaryngoscopy
Aim: In our study, we aimed to compare the effects of hemodynamic response after intubation with direct laryngoscopy that tympanoplasty and mastoidectomy undergoing surgery, endoscopic image scores obtained with videolaringoscopy in cases of intubation without muscle relaxant, which we have been using with propofol and remifentanil, the success and duration of intubation, Materials and Methods: Elective tympanoplasty and mastoidectomy surgeon planned to age between 18-65, a total of 63 subjects with ASA I-II and Mallampati score I-II were included in the study. Patients were randomly divided, according to the envelope method into two groups of 30: Group D; Group to be intubated with direct laryngoscope Group V; Group to be intubated with videolaryngoscope The patients were monitorised with ECG, noninvasive arterial pressure, SpO2 after they were taken to the operating room. Preoxygenation was performed with face mask for at least 3 minutes with 100 % O2. Anesthesia induction was given for 90 seconds with 1 mg / kg lidocaine and 3 μg / kg remifentanil for 60 seconds and then propofol was administered at 2.5 mg / kg for 30 seconds. Anesthesia was maintained with sevoflurane and 50% oxygen and 50% nitrous oxide. Systolic arterial pressure (SAP), mean arterial pressure (MAP), heart rate (HR) and SpO2 were recorded at baseline, after anesthesia induction and at 1, 3, 5, 10 and 20 minutes after intubation. The entubation conditions of the cases were evaluated according to the Helbo-Hansen Raulo intubation scoring criteria. Cormack-Lehane and Mallampati Scores, number of intubation attempts, laryngeal compression, intubation time were recorded. The incidence of complications due to intubation (oral mucozal bleeding, oesophageal intubation, desaturation), after extubation hoarseness and sore throat were recorded. Results: 63 cases were included in the study. One patient was excluded due to difficult airway observation. 62 cases were evaluated. There was no statistically significant difference between groups D and V in HR. There was no statistically significant difference between Group D and Group V in SAB and OAB after 1, 3, 5, 10 and 20 minutes after intubation. Blood pressure values showed the greatest decrease after induction but increased after intubation but no baseline value. There was a statistically significant difference between groups D (22.19 sec) and Group V (29.19 sec) with respect to the duration of intubation. Conclusion: As a result; When McGRATH® MAC videolaryngoscope compared to Macintosh direct laryngoscop in without muscle relaxant intubation, provide better intubation conditions, similar changes detected in hemodinamic response due to tracheal intubation. Key words: Intubation without muscle relaxant, Laryngoscopy, Hemodynamics, Videolaryngoscopy
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Miniksar, Ö.H. (2017). Timpanomastoidektomilerde videolaringoskopi ile kas gevşeticisiz entübasyonun hemodinami ve entübasyon koşullarına etkisi. Yayımlanmış Uzmanlık Tezi, İnönü Üniversitesi, Malatya.
