Çift lümenli tüp yerleştirilmesi için geleneksel Macintosh Bleyd, C-MAC Videolaringoskop ve yüksek açılı C-MAC D-bleyd'in kullanımının karşılaştırılması
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Göğüs cerrahisinde torakotomi veya Video destekli torakoskopik cerrahi
yapılıp, tek akciğer ventilasyonu uygulanan hastaların çift lümenli tüp entübasyonunda;
Konvansiyonel Macintosh, C-MAC Videolaringoskop Macintosh bleyd ve C-MAC
Videolaringoskop D-bleydin entübasyon süresi, entübasyon deneme sayısı, entübasyona
verilen hemodinamik yanıtlar, entübasyona bağlı gelişen komplikasyonları karşılaştırmayı
amaçladık.
Yöntem: Çalışmaya 18-90 yaş arası, torakotomi veya video destekli torakoskopik cerrahi
yapılan, çift lümenli tüp ile entübe edilen 105 hasta dahil edildi. Hastalar C-MAC Macintosh
bleyd, C-MAC D-bleyd ve Konvansiyonel Macintosh bleyd olmak üzere 3 gruba ayrıldı.
Hastaların hangi grupta olacakları kapalı opak zarf yöntemi ile belirlendi. Ameliyathaneye
alınan hastaların preoperatif havayolu değerlendirildi ve elektrokardiyografi, pulse oksimetre,
tansiyon ölçümleri kaydedildi. Hastalar preoksijenize edildikten sonra anestezi indüksiyonu
verildi ve train of four değeri 0 olduktan sonra uygun laringoskop ile entübe edildi. Entübasyon
süresi, deneme sayısı, Pogo skoru, laringoskopu yerleştirmede zorluk, tüp ilerletmede zorluk
gibi entübasyon ile ilgili olan durumlar, entübasyon sonrası 1., 3. ve 5. dakika hemodinamik
parametreler ve entübasyon sonrası gelişebilecek komplikasyonlar kaydedildi. Daha sonra
hastanın tüpünün doğru yerde olup olmadığını belirlemek amacıyla fiberoptik bronkoskopi
uygulandı ve görülen dokularda travma olup olmadığı kaydedildi. Operasyon sonrası 1. ve 24.
saatte hasta değerlendirildi, boğaz ağrısı, ses kısıklığı, disfaji, öksürük giibi postoperatif
komplikasyonlar sorgulandı ve kaydedildi.
Bulgular: Demografik veriler 3 grupta da homojen olarak dağılmıştı. Mallampati, ağız açıklığı
ve tiromental mesafe gibi preoperatif havayolu değerlendirmesi gruplar arasında benzerdi.
Gruplar arasında entübasyon ile ilgili olan tüp numarası, tüp dizaynı, Pogo skoru, Burp
manevrası, laringoskopu yerleştirmede zorluk, tüp ilerletmede zorluk ve entübasyon deneme
sayıları açısından fark yoktu. Fakat C-MAC D-bleyd grubunda 2 hasta ikinci denemede de
entübe edilemediği için laringoskop değiştirildi. Entübasyon süreleri değerlendirildiğinde ise
en kısa süre Konvansiyonel Macintosh grubunda, en uzun süre ise C-MAC D-bleyd grubunda
bulundu ve gruplar arasında anlamlı fark saptandı (p<0.01). Entübasyon sırasında ve sonrasında
gelişen komplikasyonlar, fiberoptik bronkoskopi ile farkedilen yumuşak doku travmaları,
hemodinamik parametreler ve postoperatif değerlendirilen komplikasyonlar açısından da üç
grup arasında anlamlı fark yoktu.
Sonuç: Normal havayolu olan hastalarda, çift lümenli tüp entübasyonunda Konvansiyonel
Macintosh laringoskop ile entübasyon süresi, C-MAC videolaringoskop Macintosh bleyd ve CMAC
videolaringoskop D-bleyde göre daha kısa olduğu için, çift lümenli tüp entübasyonunda
ilk seçenek laringoskop olarak Konvansiyonel Macintosh laringoskop tercih edilebilir.
Purpose: We aimed to compare the intubation time, number of intubation attempts, hemodynamic responses to intubation and intubation-related complications of the Conventional Macintosh blade, C-MAC videolaryngoscope Macintosh blade and C-MAC videolaryngoscope D-blade in the intubation of patients who underwent thoracotomy or video assisted thoracoscopic surgery in thoracic surgery and one-lung ventilation. Method: Patients were divided into 3 groups as C-MAC Macintosh blade, C-MAC D-blade and Conventional Macintosh blade. The group of patients was determined by closed opaque envelope method. The preoperative airway of the patients admitted to the operating room evaluated and electrocardiography, pulse oximetry and blood pressure measurements were made and recorded. After the patients were preoxygenated anesthesia induction was given and intubated with appropriate laryngoscope after train of four value was 0. Intubation time, number of attempts, Pogo score, intubation-related conditions such as difficulty in placing the laryngoscope, difficulty in tube advancement, hemodynamic parameters at the 1st, 3rd, 5th minutes after intubation and complications that may developed after intubation were recorded. Afterward fiberoptic bronchoscopy was performed to determined whether the patient’s tube was in the right place and any trauma to the tissues seen was recorded. Postoperative complications such as sore throat, hoarseness, dysphagia and cough were questioned and recorded. Results: Demographic data were homogeneously distributed in all 3 groups. Preoperative airway assessment including mallampathy, mouth opening and thyromental distance were similar between the groups. There was no difference between the groups in terms of intubationrelated tube number, tube design, Pogo score, Burp maneuver, difficulty in placing laryngoscope, difficulty in advancing the tube and number of intubation attempts. However, 2 patients from the C-MAC D-blade group could not be intubated in the second attempt and the laryngoscope was changed. When intubation time evaluated, the shortest time was found in the Conventional Macintosh group and the longest time was found in the C-MAC D-blade group and a significant difference was found between the groups. (p<0.01) There was no significant difference between the three groups in terms of complications that developed during and after intubation, soft tissue traumas detected by fiberoptic bronchoscopy, hemodynamic parameters and postoperative complications evaluated. Conclusion: Conventional Macintosh laryngoscope may be preferred as the first-line laryngoscope for intubation of double lumen tube in patients with a normal airway because the intubation time with the Conventional Macintosh is shorter than with the Conventional Macintosh blade and C-MAC D-blade.
Purpose: We aimed to compare the intubation time, number of intubation attempts, hemodynamic responses to intubation and intubation-related complications of the Conventional Macintosh blade, C-MAC videolaryngoscope Macintosh blade and C-MAC videolaryngoscope D-blade in the intubation of patients who underwent thoracotomy or video assisted thoracoscopic surgery in thoracic surgery and one-lung ventilation. Method: Patients were divided into 3 groups as C-MAC Macintosh blade, C-MAC D-blade and Conventional Macintosh blade. The group of patients was determined by closed opaque envelope method. The preoperative airway of the patients admitted to the operating room evaluated and electrocardiography, pulse oximetry and blood pressure measurements were made and recorded. After the patients were preoxygenated anesthesia induction was given and intubated with appropriate laryngoscope after train of four value was 0. Intubation time, number of attempts, Pogo score, intubation-related conditions such as difficulty in placing the laryngoscope, difficulty in tube advancement, hemodynamic parameters at the 1st, 3rd, 5th minutes after intubation and complications that may developed after intubation were recorded. Afterward fiberoptic bronchoscopy was performed to determined whether the patient’s tube was in the right place and any trauma to the tissues seen was recorded. Postoperative complications such as sore throat, hoarseness, dysphagia and cough were questioned and recorded. Results: Demographic data were homogeneously distributed in all 3 groups. Preoperative airway assessment including mallampathy, mouth opening and thyromental distance were similar between the groups. There was no difference between the groups in terms of intubationrelated tube number, tube design, Pogo score, Burp maneuver, difficulty in placing laryngoscope, difficulty in advancing the tube and number of intubation attempts. However, 2 patients from the C-MAC D-blade group could not be intubated in the second attempt and the laryngoscope was changed. When intubation time evaluated, the shortest time was found in the Conventional Macintosh group and the longest time was found in the C-MAC D-blade group and a significant difference was found between the groups. (p<0.01) There was no significant difference between the three groups in terms of complications that developed during and after intubation, soft tissue traumas detected by fiberoptic bronchoscopy, hemodynamic parameters and postoperative complications evaluated. Conclusion: Conventional Macintosh laryngoscope may be preferred as the first-line laryngoscope for intubation of double lumen tube in patients with a normal airway because the intubation time with the Conventional Macintosh is shorter than with the Conventional Macintosh blade and C-MAC D-blade.
Açıklama
Anahtar Kelimeler
Çift lümenli tüp, Double lumen tube, Tek akciğer ventilasyonu, One-lung ventilation, D-bleyd, D-blade, Videolaringoskop, Videolaryngoscope
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yetiş, E. (2024). Çift lümenli tüp yerleştirilmesi için geleneksel Macintosh Bleyd, C-MAC Videolaringoskop ve yüksek açılı C-MAC D-bleyd'in kullanımının karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
