Sevgi Pekcan, Funda GÖK, Osman Mücahit TOSUN, Alper KILIÇASLAN, Ruhiye REİSLİ

Çocuklarda Laringeal Maske Airway (LMA) Yerleştirilmesinin Doğrulanmasında Farklı Ultrasonografi Tekniklerinin Değerlendirilmesi

Amaç: Çocuklarda, solunum yollarındaki anatomik farklılıklar nedeniyle laringeal maske (LMA) yanlış yerleştirme ihtimali daha yüksektir. Amacımız, çocuk hastalarda LMA yerini belirlemek için, farklı ultrasonografi (USG) tekniklerinin etkinliğini değerlendirmektir. Yöntem: Yerel etik kurul onayı ve ebeveynlerden yazılı bilgilendirilmiş onam alındıktan sonra bu prospektif, gözlemsel çalışmaya 50 çocuk (1-12 yaş) hasta dahil edildi. Yerel etik kurul onayı ve ebeveynlerden yazılı bilgilendirilmiş onam alındıktan sonra bu prospektif, gözlemsel çalışmaya 50 çocuk (1-12 yaş) hasta dahil edildi. Anestezi indüksiyonundan sonra, LMA pozisyonu klinik testler ve gerçek zamanlı üst havayolu USG ile üç düzlemde (dil tabanı, larinks ve özofagusun üst ucu seviyesinde) değerlendirildi. Dil tabanı ve aritenoid kıkırdaklardaki kaf gölgelerinin simetrisi USG (aritenoid derecesi) ile değerlendirildi. Özefagusta kaf ucunun varlığı ve kafın şekli (düzgün veya bozuk) kaydedildi. LMA pozisyonu fiberoptik bronkoskopi (FOB) ile doğrulandı (FOB derecesi). FOB ve sonografik parametreler arasındaki ilişki için Spearman korelasyon ve Fisher’s exact testleri kullanıldı. Bulgular: İlk denemede klinik testler yoluyla doğru LMA yerleştirme oranının % 82 olduğu belirlenmiştir. Hastaların % 74’ünde FOB ile glottik açıklık görüntülenebildi. FOB görüntü derecesi ile dil tabanında kaf gölgelerinin asimetri varlığı arasında istatistiksel ilişki olduğu saptandı (Fisher’s exact test, p

Evaluation of Different Ultrasonography Techniques for Confirmation of Laryngeal Mask Airway (LMA) Placement in Pediatric Patients

Objective: It is likely that laryngeal mask airway (LMA) is frequently misplaced because of theanatomical differences in children’s airways. Our aim is to assess the feasibility of different ultrasonography (USG) techniques for the confirmation of the accurate placement of LMA in pediatricpopulation.Method: After a local ethics committee approval and written informed consents were obtained,50 children aged 1-12 years were consecutively included into this prospective, observationalstudy. After the anesthetic induction, the position of LMA was evaluated by clinical tests and realtime upper airway USG in three planes (at the level of tongue base, the larynx and upper end ofthe esophagus). The symmetry of the cuff shadows at the tongue base and arytenoid cartilageswas assessed by USG (arytenoid grade). The presence of cuff tip in the esophagus and the shapeof the cuff (regular or distorted) was recorded. Fiberoptic bronchoscopy (FOB) was performed toconfirm the position of LMA (FOB grade). The Spearman correlation coefficient and Fisher’s exacttests were used to test the relationship between FOB and sonographic parameters.Results: The rate of accurate LMA placement through clinical tests was determined as 82% at thefirst attempt. The rate of recognizing the glottic opening was also found as 74% with FOB. Theresult showed a statistically significant association between the asymmetry of cuff shadow at thetongue base and FOB LMA grade (Fisher’s exact test, p

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