Publication: Endotrakeal Entübasyonda Lma Ctrach ve Video Laringoskop Yöntemlerinin Karşılaştırılması
Abstract
Amaç: Endotrakeal entübasyonda direkt laringoskopla görülen Cormack ve Lehane (C-L) görüntü skoru ile LMA CTrach ve video laringoskopla elde edilen endoskopik görüntü skorlarını ve aynı zamanda LMA CTrach ile video laringoskopun entübasyon başarısını, entübasyon süresini, hemodinamik yanıt ve stres yanıt üzerine etkilerini karşılaştırmayı amaçladık.Gereç ve Yöntem: Çalışmaya 18?65 yaş arasında değişen ASA I-III sınıflamasına giren elektif cerrahi uygulanacak 100 hasta dâhil edildi. Hastalar rastgele 50'şerli iki gruba ayrıldı;Grup C: LMA CTrach ile entübasyonu yapılan grupGrup V: Video laringoskop ile entübasyonu yapılan grupHastaların preoperatif muayenesinde yaş, cinsiyet, kilo, dişler, tiromental mesafe, mandibula köşesi ile çene ucu uzunluğu, ağız açıklığı, boyun hareketleri ve Mallampati skorları kaydedildi.Hastalara operasyon odasına alındığında preoperatif rutin monitörizasyon yapıldı. Her iki grup için de anestezi indüksiyonu 2?3 mg/kg propofol ve 1mcg/kg fentanil ile sağlandı. Akciğerlerin havalandığı görülünce 0.1 mg/kg vekuronyum kas gevşemesi için uygulandı. Her iki gruba dört yılını tamamlamış bir asistan tarafından Macintosh Laringoskop ile direkt laringoskopi uygulanarak C-L skoru kaydedildi ve sonrasında hastalar bir dakika daha maske ile ventile edildi. Daha sonra dört yılını tamamlamış ve daha önce en az 5 sefer LMA CTrach'ı kullanmış olan tez asistanı tarafından Grup C'deki hastalara LMA CTrach yerleştirildi ve endoskopik görüntü skorları değerlendirildi. LMA CTrach ile ventilasyonu sağlanan hastalarda endotrakeal tüp yerleştirildi ve tüp değiştirici yardımı ile LMA CTrach çıkarıldı. Üçüncü denemede de başarısız olunan olgular Macintosh Laringoskop ile entübe edildi. Grup V'de ise Macintosh Laringoskop ile Grup C'de bu işlemi yapan anestezi asistanı tarafından direkt laringoskopi uygulanarak C-L skoru kaydedildi ve sonrasında hastalar yine 1 dakika daha maske ile ventile edildi. Daha sonra tez asistanı tarafından video laringoskop ile endoskopik görüntü skoru değerlendirildikten sonra entübasyon gerçekleştirildi.Hastaların kalp atım hızı, sistolik arter basıncı, diyastolik arter basıncı, ortalama arter basıncı, periferik oksijen satürasyonu indüksiyondan önce, indüksiyondan sonra, entübasyondan hemen sonra, entübasyondan sonraki 1. 3. 5. 10. 20. 25. ve 30. dakikalarda kaydedildi. End tidal karbondioksit ise entübasyondan hemen sonra, entübasyondan sonraki 1. 3. 5. 10. 15. 20. 25. ve 30. dakikalarda kaydedildi.Bulgular: Grupların demografik özellikleri ve ASA sınıflaması benzerdi (p>0.05). Hastalarda dişlerin anatomik yapısının, tiromental mesafenin, mandibula ramusu ile çene ucu arasındaki mesafenin, ağız açıklığının, boyun hareketlerinin ve Mallampati sınıflamasının gruplara göre dağılımı benzerdi (p>0.05). C-L ve endoskopik görüntü skorları arasında Grup C'de anlamlı fark bulundu (p<0.05); Grup V'de ise anlamlı bir farka rastlanmadı (p>0.05). Her iki grup arasında entübasyon başarısı açısından anlamlı fark yoktu (p>0.05). Entübasyon süreleri karşılaştırıldığında ise anlamlı bir fark görüldü (p<0.001).Grup C'ye ait indüksiyon öncesindeki, indüksiyondan sonraki, entübasyondan hemen sonraki, entübasyon sonrası 1. 3. ve 5. dakikalardaki sistolik arter basınç değerleri Grup V'ye göre anlamlı yüksek bulundu (p<0.05). Grup C'ye ait indüksiyon öncesindeki, entübasyondan hemen sonraki, entübasyondan sonra 1. 3. 5. 10. ve 20. dakikalardaki diastolik arter basıncı ve ortamla arter basınç değerleri Grup V'ye göre anlamlı yüksek bulundu (p<0.05). Grup C'ye ait entübasyondan hemen sonraki ortalama kalp hızı değeri Grup V'ye göre anlamlı yüksek bulundu (p=0.045). Grup V'ye ait indüksiyondan sonraki, entübasyondan hemen sonraki, entübasyon sonrası 10. 15. 20. 25. ve 30. dakikalardaki periferik oksijen satürasyonu değerleri Grup C'ye göre anlamlı yüksek bulundu (p<0.05). Gruplar arasında end-tidal karbondioksit açısından anlamlı bir fark bulunmadı (p>0.05).Hemodinamik parametrelerin indüksiyondan önceki ve entübasyondan hemen sonraki değerlerinin değişim yüzdelerinin dağılımı değerlendirildiğinde sistolik arter basıncı, diastolik arter basıncı, ortalama arter basıncı, kalp hızı ve oksijen satürasyonu değerlerindeki değişim yüzdeleri açısından iki grup arasında fark görülmedi (p>0.05).Sonuç: Yaptığımız çalışma neticesinde video laringoskopun günlük pratikte daha rahat kullanılabileceği, LMA CTrach'ın ise pratik kullanımının zor olduğu kanaatine vardık. Ancak endoskopik görüntü skorları karşılaştırıldığında LMA CTrach grubunda daha iyi bir görüntü elde ettiğimizden, zor entübasyon düşünülen hastalarda alternatif bir yöntem olarak LMA CTrach'ın da kullanılabileceğini düşünmekteyiz.Anahtar kelimeler: Endotrakeal entübasyon, LMA CTrach, Video Laringoskop, Hemodinamik Parametreler.
Objective: In this study, our objective was to compare, the Cormack and Lehane (C ? L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of LMA CTrach and video laryngoscope. We also compared the achievement of endoscopy with LMA CTrach and video laryngoscopy, entubation time, and its effects on hemodynamic and stress responses.Materials and methods: The study included 100 patients, ASA I ? III, aged 18 ? 65, who will undergo elective surgery. Patients were randomly divided into two groups, each including 50 patients. In Group C, there were patients intubated with LMA CTrach and in Group V the patients, intubated with video laryngoscope. In the preoperative examination; age, gender, weight, teeth, the thyromental distance, the length between the mandibular corner and chin end, mouth opening, head ? neck movement and Mallampati scores were evaluated and recorded.Routine monitoring of patients were done preoperatively in the operation room. Anesthesia was induced with the administration of 2 ? 3 mg/kg propofol and 1 mcg/kg fentanyl for both groups. When the lungs ventilated, 0.1 mg/kg vecuronium was administered for muscle relaxation. The patients in both groups underwent direct larygoscopy with a Macintosh Laryngoscope, and their C ? L scores were recorded. This process was carried out by a junior hospital doctor, who has attended anesthesiology education for four years. After this process, patients were ventilated with masks for 1 minute. Then, the research assistant doctor, who has attended anesthesiology for four years, has applied LMA CTrach to the patients in Group C, and their endoscopic sight scores were evaluated. The endotracheal tubes were inserted to the patients, who were ventilated with LMA CTrach. Then, the LMA CTrach were removed from the patients, by using an endotracheal tube changer. In cases, in which these three trials have failed, endotracheal intubation was carried out by a Macintosh laryngoscope. In Group V, direct laryngoscopy was applied to the patients by the same research assistant, that applied the processes in Group C. The C ? L scores of the patients were recorded. Then, the patients were ventilated with masks, for 1 minute. The intubation was carried out, after the research assistant evaluated the endoscopic sight scores with video laryngoscope.Heart rates, systolic, diastolic, and mean blood pressures, SpO2 of the patients were recorded before and after the induction, just after and the 1., 3., 5., 10., 20., 25., 30. minutes of intubation.Results: The demographic characteristics and the ASA classifications of the groups were similar (p>0.05). Two groups were similar in terms of statistical distribution of measurements such as; the anotomical structure of patients? teeth, thyromental distance, the distance between the mandibular ramus and chin end, head ? neck movements, and Mallampati scores (p>0.05).In Group C there was a significant difference between C ? L and endoscopic sight scores (p>0.05). No significant difference could be detected in Group V (p>0.05). Regarding the success of the intubation, no significant difference could be detected between two groups (p>0.05). However, when intubation times were compared, there was a significant difference between two groups (p< 0.001). The intübation time was longer in group C.Systolic blood pressures of the Group C, before and after the induction, and just after the intubation, and in the 1st, 3rd, and 5th minutes during the intubation, were significantly higher than Group V (p< 0.05). Diastolic and mean blood pressures of the Group C, before the induction, and just after the intubation, and in the 1st, 3rd, 5th, 10th, and 20th minutes during the intubation were also significantly higher than Group V (p< 0.05). Mean heart rate, just after the intubation, was significantly higher in Group C than in Group V (p=0.045). SpO2 values of Group V, after the induction, and just after the intubation, and in the 10th, 15th, 20th, 25th, and 30th minutes during the intubation, were significantly higher than those of Group C (p< 0.05). There was no significant difference between groups, regarding the end tidal CO2.When the distribution of the percentile changes in the values of the hemodynamical parameters, before the induction and just after the intubation, were assessed; there was no difference between two groups, in terms of the percentile changes of systolic, diastolic, and mean blood pressures, heart rates, and SpO2 values of the patients (p> 0.05).Conclusion: As a conclusion of our study; it can be stated that the video laryngoscopy can easily be implemented for daily uses, whereas LMA CTrach is diffucult to use for practical purposes. However, when endoscopic sight scores were compared, a better sight was obtained in the LMA CTrach group. Therefore, in cases where the intubation is diffucult to be applied in patients, LMA CTrach can be resorted as an alternative application.Key words: Endotracheal intubation, LMA Ctrach, Video laryngoscope, Hemodynamic variables.
Objective: In this study, our objective was to compare, the Cormack and Lehane (C ? L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of LMA CTrach and video laryngoscope. We also compared the achievement of endoscopy with LMA CTrach and video laryngoscopy, entubation time, and its effects on hemodynamic and stress responses.Materials and methods: The study included 100 patients, ASA I ? III, aged 18 ? 65, who will undergo elective surgery. Patients were randomly divided into two groups, each including 50 patients. In Group C, there were patients intubated with LMA CTrach and in Group V the patients, intubated with video laryngoscope. In the preoperative examination; age, gender, weight, teeth, the thyromental distance, the length between the mandibular corner and chin end, mouth opening, head ? neck movement and Mallampati scores were evaluated and recorded.Routine monitoring of patients were done preoperatively in the operation room. Anesthesia was induced with the administration of 2 ? 3 mg/kg propofol and 1 mcg/kg fentanyl for both groups. When the lungs ventilated, 0.1 mg/kg vecuronium was administered for muscle relaxation. The patients in both groups underwent direct larygoscopy with a Macintosh Laryngoscope, and their C ? L scores were recorded. This process was carried out by a junior hospital doctor, who has attended anesthesiology education for four years. After this process, patients were ventilated with masks for 1 minute. Then, the research assistant doctor, who has attended anesthesiology for four years, has applied LMA CTrach to the patients in Group C, and their endoscopic sight scores were evaluated. The endotracheal tubes were inserted to the patients, who were ventilated with LMA CTrach. Then, the LMA CTrach were removed from the patients, by using an endotracheal tube changer. In cases, in which these three trials have failed, endotracheal intubation was carried out by a Macintosh laryngoscope. In Group V, direct laryngoscopy was applied to the patients by the same research assistant, that applied the processes in Group C. The C ? L scores of the patients were recorded. Then, the patients were ventilated with masks, for 1 minute. The intubation was carried out, after the research assistant evaluated the endoscopic sight scores with video laryngoscope.Heart rates, systolic, diastolic, and mean blood pressures, SpO2 of the patients were recorded before and after the induction, just after and the 1., 3., 5., 10., 20., 25., 30. minutes of intubation.Results: The demographic characteristics and the ASA classifications of the groups were similar (p>0.05). Two groups were similar in terms of statistical distribution of measurements such as; the anotomical structure of patients? teeth, thyromental distance, the distance between the mandibular ramus and chin end, head ? neck movements, and Mallampati scores (p>0.05).In Group C there was a significant difference between C ? L and endoscopic sight scores (p>0.05). No significant difference could be detected in Group V (p>0.05). Regarding the success of the intubation, no significant difference could be detected between two groups (p>0.05). However, when intubation times were compared, there was a significant difference between two groups (p< 0.001). The intübation time was longer in group C.Systolic blood pressures of the Group C, before and after the induction, and just after the intubation, and in the 1st, 3rd, and 5th minutes during the intubation, were significantly higher than Group V (p< 0.05). Diastolic and mean blood pressures of the Group C, before the induction, and just after the intubation, and in the 1st, 3rd, 5th, 10th, and 20th minutes during the intubation were also significantly higher than Group V (p< 0.05). Mean heart rate, just after the intubation, was significantly higher in Group C than in Group V (p=0.045). SpO2 values of Group V, after the induction, and just after the intubation, and in the 10th, 15th, 20th, 25th, and 30th minutes during the intubation, were significantly higher than those of Group C (p< 0.05). There was no significant difference between groups, regarding the end tidal CO2.When the distribution of the percentile changes in the values of the hemodynamical parameters, before the induction and just after the intubation, were assessed; there was no difference between two groups, in terms of the percentile changes of systolic, diastolic, and mean blood pressures, heart rates, and SpO2 values of the patients (p> 0.05).Conclusion: As a conclusion of our study; it can be stated that the video laryngoscopy can easily be implemented for daily uses, whereas LMA CTrach is diffucult to use for practical purposes. However, when endoscopic sight scores were compared, a better sight was obtained in the LMA CTrach group. Therefore, in cases where the intubation is diffucult to be applied in patients, LMA CTrach can be resorted as an alternative application.Key words: Endotracheal intubation, LMA Ctrach, Video laryngoscope, Hemodynamic variables.
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