Bariatrik Cerrahide Havayolu Yönetimi Deneyimlerimiz

Amaç: Obez hastalar, obez olmayan hastalara göre hava yolu morbiditesi açısından daha risklidirler. Ancak literatürde, obezlerde zor trakeal entübasyon ve zor maske ventilasyonunu ön gösterecek faktörler ile ilgili çelişkili veriler bulunmaktadır. Yöntem: Laparoskopik sleeve gastrektomi ameliyatı geçiren 196 hasta çalışmaya dahil edildi. Rokuronyum ile nöromüsküler blokaj (NMB) sağlandı. Ameliyat sonunda, sugammadeks ile NMB’nin tamamen geri dönüşü sağlandı. Mallampati skorları, Cormack-Lehane skorları, entübasyon deneme sayısı, ventilasyon ve Obstrüktif uyku apne sendromu (OSAS) verileri kaydedildi. Bulgular: Mallampati skoru 4, zor ventilasyon durumu ve OSAS ile ilişkili bulundu. Ayrıca, Cormack-Lehane skoru 4 olan hastaların hiçbiri ilk denemede entübe edilemedi. Daha yüksek Cormack-Lehane skorları (3 ve 4), daha zor ventilasyon durumu ve OSAS ile ilişkili bulundu. Standart indüksiyon ve transtrakeal entübasyon sırasında, anestezi uzmanlarında endişe duyusu hiç, orta ve yüksek olarak sorgulandı. Standart indüksiyon ve transtrakeal entübasyonun %98.5’i sırasında anestezi uzmanları endişe durumlarını “hiç” olarak belirttiler. OSAS ileri yaş ile ilişkili bulundu. Sonuç: BMI tek başına zor entübasyonu öngörmezken, obez hastalarda anatomik nedenlerden dolayı maske ventilasyonu tahmin edilebileceği gibi zordu. OSAS hastaları ve yüksek Mallampati skoru (3 ve 4) olan morbid obez hastaların entübasyonu zor olabilir. Ameliyathanede sugammadeks varlığı anestezistleri cesaretlendirmektedir.

Airway Management Experiences In Bariatric Surgery

Objective: Obese patients are hazardous due to airway morbidity as against to the non-obese.However, there are contradictory data about predicting factors of tracheal intubation and maskventilation in morbidly obese people.Methods: We studied 196 patients undergone laparoscopic sleeve gastrectomy surgery.Neuromuscular blockade (NMB) was achieved with rocuronium. At the end of the surgery, complete reversal of NMB was obtained with sugammadex. Mallampati scores, Cormack-Lehanescores, number of intubation attempts, ventilation and OSAS descriptives were recorded.Results: Mallampati 4 scores were related to higher difficult ventilation situation and OSAS. Also,none of Cormack-Lehane 4 scores were intubated at first attempt. Higher Cormack-Lehane scores(3 and 4) were related to higher difficult ventilation situation and OSAS. During standard induction and transtracheal intubation, the sense of concern in anesthesiologists was recorded asnone, moderate and high. During 98.5% of standard induction and transtracheal intubation,anesthesiologists declared they had no concerns. Difficult ventilation situation was not related toage. OSAS was related to higher ages.Conclusion: BMI is not a predictable factor for difficult intubation,however difficult mask ventilation can predict difficult intubation in obese patients because of anatomical reasons. Also presence of obstructive sleep apnea syndrome (OSAS) and high Mallampati class situations maycause difficult intubation. Presence of sugammadex in the operating room may encourage anesthesiologists.

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