Publication: Jinekolojik Cerrahi Geçiren Hipertansif Hastalarda C-mac Videolaringoskop ve Macintosh Laringoskopun Hemodinamik Yanıt, Qtc, Tpe, Qtc Tpe Oranı, Entübasyon Skorları ve Yan Etkiler Açısından Karşılaştırılması
Abstract
ÖZET Giriş ve Amaç: Endotrakeal entübasyon, genel anestezi uygulamalarında havayolunu korumak ve havayoluna erişim sağlamayabilmek için altın standart yöntemdir. Ancak laringoskopi ve endotrakeal entübasyon sırasında somato-visseral refleksler aracılığıyla sempatik yanıtlar ortaya çıkar. Bu yanıtlar, artan katekolamin düzeyleri nedeniyle taşikardi, kan basıncı değişiklikleri ve aritmilere yol açabilir. Hipertansif hastalarda bu yanıtlar sağlıklı bireylere göre daha belirgin olabilir. Çalışmamızın amacı, jinekolojik cerrahi geçirecek hipertansif hastalarda farklı laringoskop kullanımlarının endotrakeal entübasyon başarısı, hemodinamik değişiklikler, aritmojenik özellikler ve yan etkiler açısından retrospektif olarak karşılaştırılmasıdır. Gereç ve Yöntem: Bu retrospektif çalışma, 01-04-2021 ile 01-09-2021 tarihleri arasında Samsun Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi'nde Video laringoskop ve Macintosh laringoskop kullanılarak entübe edilen jinekolojik cerrahi geçiren hipertansif hastaların dosyalarının incelenmesiyle gerçekleştirildi. Çalışmaya 18-65 yaş arası toplam 70 hipertansif hasta dahil edildi. Çalışmamızın birincil amacı, her iki grupta entübasyon başarısını, entübasyon skorlarını, hemodinamik parametreleri ve EKG'deki QTc, Tpe ve QTc/Tpe intervallerini değerlendirmekti. Ayrıca, laringoskopi ve endotrakeal entübasyon sırasında meydana gelen veya postoperatif dönemde görülen komplikasyonlar ve yan etkiler de değerlendirildi. Bulgular: Demografik veriler her iki grupta benzer bulundu (her biri için p>0.05). Glottisi bulma ve entübasyon süreleri ML grubunda daha uzun (her biri için p <0,001), deneme sayısı ve Cormack- Lehane ve POGO skoru her iki grupta benzer bulundu (her biri için p>0.05). Kalp atım hızı endotrakeal entübasyon sonrası 1. dakikada ML grubunda daha yüksek (p <0,001), entübasyon sonrası 3. ve 5. dakikada her iki grupta benzer bulundu (p>0.05). Entübasyon sonrası 1., 3. ve 5. dakika sistolik kan basıncı (her biri için p<0.05), diyastolik kan basıncı (1. dakika için p=0.005, 3. dakika için p=0.001 ve 5. dakika için p<0.001) ve ortalama arter basıncı değerleri (1. dakika için p=0.002, 3. dakika için p<0.001, 5. dakika için p<0.001) ML grubunda daha yüksek olarak saptandı. QTc değerleri tüm ölçüm noktalarında her iki grupta benzer saptandı (her biri için p>0.05) ancak, grup içi karşılaştırmada ML grubunda, entübasyon sonrası 1., 3., ve 5. dakikadaki QTc değerleri bazal QTc değerlerinden anlamlı şekilde daha uzun bulundu (her biri için p<0,001). Tpe mesafesi endotrakeal entübasyon sonrası 3. dakika değeri ML grubunda daha yüksek bulundu (p=0,027). Anestezi ve entübasyona dair toplam yan etkiler ML grubunda anlamlı biçimde daha yüksek oranda gözlendi (p=0.020). Sonuç: Sonuç olarak; normal havayolu olan hipertansif hastalarda, videolaringoskopların kullanımı, entübasyon ve glottisi bulma süresini kısaltıp laringoskopi ve endotrakeal entübasyon sırasında ortaya çıkabilecek aritmi riskini, abartılı hemodinamik fluktuasyonları ve postoperatif komplikasyon oranını azaltarak bu popülasyonda güvenle kullanılabilir. Anahtar Sözcükler: Hipertansif hastalar; Endotrakeal entübasyon; Macintosh laringoskop; C-MAC videolaringoskop, QTc, Tpe, QTc/Tpe
ABSTRACT Objective: Endotracheal intubation is the gold standard method for protecting the airway and ensuring access to the airway during general anesthesia. However, during laryngoscopy and endotracheal intubation, sympathoadrenal responses occur through somatovisceral reflexes. These responses can lead to tachycardia, blood pressure changes, and arrhythmias due to increased catecholamine levels. In hypertensive patients, these responses may be more pronounced compared to healthy individuals. Our study aims to retrospectively compare the success of endotracheal intubation, hemodynamic changes, and arrhythmogenic properties of different laryngoscope usages in hypertensive patients. Method: This retrospective study was conducted by examining the files of hypertensive patients intubated using video laryngoscope and Macintosh laryngoscope at Samsun Ondokuz Mayıs University Medical Faculty Hospital between 01-04-2021 and 01-09-2021. A total of 70 hypertensive patients aged 18-65 who underwent gynecological surgery were included in the study. The primary aim of our study was to evaluate intubation success, intubation scores, hemodynamic parameters, and QTc, Tpe, and QTc/Tpe values on the ECG in both groups. Additionally, complications occurring during laryngoscopy and endotracheal intubation or observed in the postoperative period were also evaluated. Results: Demographic data were found to be similar in both groups (p>0.05 for each). The times to find the glottis and intubation were longer in the ML group (p<0.001 for each), while the number of attempts and Cormack-Lehane and POGO scores were similar in both groups (p>0.05 for each). Heart rate was higher in the ML group at the 1st minute after endotracheal intubation (p<0.001), but similar in both groups at the 3rd and 5th minutes after intubation (p>0.05). Systolic blood pressure at the 1st, 3rd, and 5th minutes after intubation (p<0.05 for each), diastolic blood pressure (p=0.005 for the 1st minute, p=0.001 for the 3rd minute, and p<0.001 for the 5th minute), and mean arterial pressure values (p=0.002 for the 1st minute, p<0.001 for the 3rd minute, and p<0.001 for the 5th minute) were found to be higher in the ML group. QTc values were found to be similar in both groups at all measurement points (p>0.05 for each), however, intra-group comparison in the ML group showed that QTc values at the 1st, 3rd, and 5th minutes after intubation were significantly longer than the baseline QTc values (p<0.001 for each). The Tpe interval at the 3rd minute after endotracheal intubation was found to be higher in the ML group (p=0.027). The total side effects related to anesthesia and intubation were observed at a significantly higher rate in the ML group (p=0.020). Conclusion: In conclusion, in hypertensive patients with normal airways, the use of videolaryngoscopes can be safely employed in this population by shortening the time to intubation and finding the glottis, reducing the risk of arrhythmias that may occur during laryngoscopy and endotracheal intubation, minimizing exaggerated hemodynamic fluctuations, and decreasing the rate of postoperative complications. Keywords: Hypertensive patients; Endotracheal intubation; Macintosh laryngoscope; C-MAC video laryngoscope, QTc, Tpe, QTc/Tpe
ABSTRACT Objective: Endotracheal intubation is the gold standard method for protecting the airway and ensuring access to the airway during general anesthesia. However, during laryngoscopy and endotracheal intubation, sympathoadrenal responses occur through somatovisceral reflexes. These responses can lead to tachycardia, blood pressure changes, and arrhythmias due to increased catecholamine levels. In hypertensive patients, these responses may be more pronounced compared to healthy individuals. Our study aims to retrospectively compare the success of endotracheal intubation, hemodynamic changes, and arrhythmogenic properties of different laryngoscope usages in hypertensive patients. Method: This retrospective study was conducted by examining the files of hypertensive patients intubated using video laryngoscope and Macintosh laryngoscope at Samsun Ondokuz Mayıs University Medical Faculty Hospital between 01-04-2021 and 01-09-2021. A total of 70 hypertensive patients aged 18-65 who underwent gynecological surgery were included in the study. The primary aim of our study was to evaluate intubation success, intubation scores, hemodynamic parameters, and QTc, Tpe, and QTc/Tpe values on the ECG in both groups. Additionally, complications occurring during laryngoscopy and endotracheal intubation or observed in the postoperative period were also evaluated. Results: Demographic data were found to be similar in both groups (p>0.05 for each). The times to find the glottis and intubation were longer in the ML group (p<0.001 for each), while the number of attempts and Cormack-Lehane and POGO scores were similar in both groups (p>0.05 for each). Heart rate was higher in the ML group at the 1st minute after endotracheal intubation (p<0.001), but similar in both groups at the 3rd and 5th minutes after intubation (p>0.05). Systolic blood pressure at the 1st, 3rd, and 5th minutes after intubation (p<0.05 for each), diastolic blood pressure (p=0.005 for the 1st minute, p=0.001 for the 3rd minute, and p<0.001 for the 5th minute), and mean arterial pressure values (p=0.002 for the 1st minute, p<0.001 for the 3rd minute, and p<0.001 for the 5th minute) were found to be higher in the ML group. QTc values were found to be similar in both groups at all measurement points (p>0.05 for each), however, intra-group comparison in the ML group showed that QTc values at the 1st, 3rd, and 5th minutes after intubation were significantly longer than the baseline QTc values (p<0.001 for each). The Tpe interval at the 3rd minute after endotracheal intubation was found to be higher in the ML group (p=0.027). The total side effects related to anesthesia and intubation were observed at a significantly higher rate in the ML group (p=0.020). Conclusion: In conclusion, in hypertensive patients with normal airways, the use of videolaryngoscopes can be safely employed in this population by shortening the time to intubation and finding the glottis, reducing the risk of arrhythmias that may occur during laryngoscopy and endotracheal intubation, minimizing exaggerated hemodynamic fluctuations, and decreasing the rate of postoperative complications. Keywords: Hypertensive patients; Endotracheal intubation; Macintosh laryngoscope; C-MAC video laryngoscope, QTc, Tpe, QTc/Tpe
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