Boyun anatomik yapılarının ultrasonografik ve antropometrik ölçümlerinin zor havayolu ile olan ilişkisinin değerlendirilmesi
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Tarih
2022
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Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Zor laringoskopi veya entübasyon insidansı %1,5 ile %13 arasında değişmektedir. Başarısız entübasyon, anesteziye bağlı ölüm ve kalıcı beyin hasarının nedenlerinden biridir. Bu çalışmamızda primer olarak, zor havayolu ve zor laringoskopi prosedürünün ultrasonografik ölçümlerle öngörülebilme potansiyelinin (spesifite ve sensitivite) değerlendirilmesi, ikincil olarak da zor havayolu olan elektif cerrahi hastalarının ölçümlerinin zor hava yolu olmayanlarla karşılaştırılması amaçlandı. Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Girişimsel Olmayan Sağlık Araştırmaları Etik Kurulun'nun 21.06.2021 tarihli, 2021/160 numaralı etik kurul onayı alınarak gerçekleştirildi. Çalışmaya elektif cerrahi endikasyonu ile genel anestezi altında endotrakeal entübasyon uygulanacak, ASA I-III grubunda, 18-65 yaş arası 170 hasta alındı. Preoperatif değerlendirmede ilk anestezist tarafından hastaların antropometrik ölçümleri ve ultrasonografik ölçümleri alınmıştır. Hastalar aynı indüksiyon anestezik ajanlar kullanılarak preoperatif değerlendirme sonuçlarını bilmeyen en az 3 yıl deneyimli ikinci anestezist tarafından entübe edilmiştir. Macintosh 3 veya 4 nolu bleydler kullanılarak ilk denemedeki ve herhangi bir manevra yapılmadan olan laringoskopik görünüme göre Cormack-Lehane sınıflandırılması belirlendi. Entübasyonun kaçıncı denemede yapılabildiği belirtildi. Zor maske ventilasyonu, zor entübasyon, kolay ve zor laringoskopi değerlendirilmeleri yapıldı. Tek değişkenli analiz sonuçlarına göre anlamlı farklılık gösteren ultrason ölçümlerinin zor entübasyonu ayırt etme başarısını değerlendirmek ve cutt-off değerlerini belirlemek amacıyla ROC eğrisi analizi kullanılmıştır. Sonuçlar: Demografik ve klinik özellikler bakımından karşılaştırmalarda kolay entübasyon (n=142) ve zor entübasyon(n=28) arasında boy, kilo ve boyun çevresi bakımından anlamlı fark saptandı (sırasıyla p değerleri 0,017; 0,002; <0,001). Zor entübasyon sayıları açısından kadın cinsiyette daha az erkeklerde daha fazla olduğu saptandı (p=0,001). Mallampati grade III 'de en fazla olmak üzere grade IV 'anlamlı fazla olduğu saptandı (p <0,001). Kolay ve zor entübasyon arasında başta dil kalınlığı olmak üzere boyun yapılarıyla cilt arası mesafelerde anlamlı farklılık saptandı. iii Ultrason ölçümleri için ROC eğrisi analizi sonuçlarına göre sensitivite ve spesifitesi en yüksek ölçümlerin dil kalınlığı ve cilt-epiglot arası mesafe olduğu gözlemlendi (Cut-off değerleri sırasıyla ?59,85; ?28,40). Tartışma: Ultrasonografik ölçümlerin zor entübasyon öngörüsünde dil kalınlığı ve epiglottis cilt kalınlığı dışındaki ölçüm parametreleri açısından orta ve zayıf derecede sensitivite ve spesifiteye sahip olduğu izlenmiştir. Anahtar Kelimeler: laringoskopi, zor havayolu, ultrasonografi
Background: The incidence of difficult laryngoscopy or intubation varies between 1.5% and 13%. Unsuccessful intubation is one of the causes of anesthesia-related death and permanent brain damage. In this study, we primarily evaluated the predictive potential (specificity and sensitivity) of difficult airway and difficult laryngoscopy procedure with ultrasonographic measurements. Secondly, the measurements of elective surgery patients with difficult airway were compared with those without difficult airway. Material and Methods: The study was carried out with the approval of Duzce University Faculty of Medicine Non-Interventional Health Research Ethics Committee dated 21.06.2021 and numbered 2021/160. In the ASA I-III group, 170 patients between the ages of 18-65 years who will undergo endotracheal intubation under general anesthesia with an indication for elective surgery were included in the study. 170 patients were recruited. In the preoperative evaluation, anthropometric measurements and ultrasonographic measurements of the patients were taken by the first anesthetist. The patients were intubated using the same induction anesthetic agents by a second anesthetist with at least 3 years of experience who did not know the results of the preoperative evaluation. Using Macintosh 3 or 4 blades, Cormack-Lehane classification was determined according to the laryngoscopic appearance in the first trial and without any maneuver. It was stated that intubation could be performed in the first attempt. Difficult mask ventilation, difficult intubation, easy and difficult laryngoscopy were evaluated. Results: : In comparisons in terms of demographic and clinical characteristics, a significant difference was found between easy intubation (n=142) and difficult intubation (n=28) in terms of height, weight and neck circumference (p values 0.017; 0.002; <0.001, respectively). It was determined that the number of difficult intubations was less in females and more in males (p=0.001). Grade IV was found to be significantly higher, with Mallampati being the highest in grade III (p <0.001). A significant difference was found between easy and difficult intubation, especially in tongue thickness, and in the distances between neck structures and skin. According to v the results of ROC curve analysis for ultrasound measurements, it was observed that the measurements with the highest sensitivity and specificity were tongue thickness and distance between skin and epiglottis (Cut-off values ?59.85; ?28.40, respectively). Conclusion: It was observed that ultrasonographic measurements had moderate to weak sensitivity and specificity in terms of measurement parameters other than tongue thickness and epiglottis skin thickness in predicting difficult intubation. Keywords: laryngoscopy, difficult airway, ultrasonography
Background: The incidence of difficult laryngoscopy or intubation varies between 1.5% and 13%. Unsuccessful intubation is one of the causes of anesthesia-related death and permanent brain damage. In this study, we primarily evaluated the predictive potential (specificity and sensitivity) of difficult airway and difficult laryngoscopy procedure with ultrasonographic measurements. Secondly, the measurements of elective surgery patients with difficult airway were compared with those without difficult airway. Material and Methods: The study was carried out with the approval of Duzce University Faculty of Medicine Non-Interventional Health Research Ethics Committee dated 21.06.2021 and numbered 2021/160. In the ASA I-III group, 170 patients between the ages of 18-65 years who will undergo endotracheal intubation under general anesthesia with an indication for elective surgery were included in the study. 170 patients were recruited. In the preoperative evaluation, anthropometric measurements and ultrasonographic measurements of the patients were taken by the first anesthetist. The patients were intubated using the same induction anesthetic agents by a second anesthetist with at least 3 years of experience who did not know the results of the preoperative evaluation. Using Macintosh 3 or 4 blades, Cormack-Lehane classification was determined according to the laryngoscopic appearance in the first trial and without any maneuver. It was stated that intubation could be performed in the first attempt. Difficult mask ventilation, difficult intubation, easy and difficult laryngoscopy were evaluated. Results: : In comparisons in terms of demographic and clinical characteristics, a significant difference was found between easy intubation (n=142) and difficult intubation (n=28) in terms of height, weight and neck circumference (p values 0.017; 0.002; <0.001, respectively). It was determined that the number of difficult intubations was less in females and more in males (p=0.001). Grade IV was found to be significantly higher, with Mallampati being the highest in grade III (p <0.001). A significant difference was found between easy and difficult intubation, especially in tongue thickness, and in the distances between neck structures and skin. According to v the results of ROC curve analysis for ultrasound measurements, it was observed that the measurements with the highest sensitivity and specificity were tongue thickness and distance between skin and epiglottis (Cut-off values ?59.85; ?28.40, respectively). Conclusion: It was observed that ultrasonographic measurements had moderate to weak sensitivity and specificity in terms of measurement parameters other than tongue thickness and epiglottis skin thickness in predicting difficult intubation. Keywords: laryngoscopy, difficult airway, ultrasonography
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
