Nil KURT, Kubilay METİN, İbrahim KURT, Feray GÜRSOY, Ayşe GÜREL

Kronik sigara kullanımının mikrolaringeal tüple venitlasyona etkisi

Çalışmanın amacı süspansiyon laringoskopi için mikrolaringeal tüple entübe edilen ve düşük tidal volüm, yüksek solunum sayısıyla İPPV uygulanan hastalarda kronik sigara kullanımının solunum mekaniklerine ve arteriyel - endtidal karbondioksit basınç farkına olan etkilerini araştırmaktır. Çalışma ASA sınıflaması I-II olup sigara kullanan 22 ve sigara kullanmayan 18 hastada etik komite onayı alındıktan sonra yapıldı. Tüm hastalara aynı anestezi indüksiyonu ve idamesi uygulandı. Entübasyonda erkekler için iç çapı 5.5 mm, kadınlar için 5 mm olan mikrolaringeal tüp kullanıldı ve solunum sayısı 20 $dk^-1$ , tidal volüm 5 ml $kg^-1$ olacak şekilde İPPV uygulandı. Entübasyondan önce kalp hızı, ortalama arteryel kan basıncı, SpO2 ve PaCO2 değerleri, entübasyondan sonra bunlara ek olarak PetC02, hava yolu direnci, plato ve tepe hava yolu basınçları 5 dakika arayla 25 dakika süresince kaydedildi. Arteryel - end-tidal karbondioksit basınçları arasındaki fark hesaplandı. Sigara kullanan grupta ameliyat sırasında tepe hava yolu basıncının başlangıca göre, hava yolu direncinin ise başlangıç ve sigara kullanmayan gruba göre daha yüksek olduğu, kompliyansın da başlangıca göre azalma gösterdiği izlendi (p

Anahtar Kelimeler:

Havayolu direnci, Sigara içme, Larinks, Laringoskopi

The effects of chronic smoking on microlaryngeal tube ventilation

This study was designed to investigate the effects of chronic smoking on ventilatory mechanics and arterial and end-tidal carbon dioxide partial pressures in patients intubated with microlaryngeal tubes and ventilated using low tidal volumes and high frequencies during suspension laryngoscopy. The study was undertaken in 22 chronic smokers and 18 non-smokers ASA I-II patients follomng ethics committee approval. Anesthesia was induced and maintained similarly in all patients. Male andfemale patients were intubated with microlaryngeal tubes with an inner diameter of 5.5 and 5.0 mm, respectıvely, and ventilated with a tidal volume of 5 ml $kg^-1$ and a respiratory frequency of 20 dk1. Heart rate, mean arterial pressure, SpO2 and PaCO2 values were monitored. in addition to these, PetCO2, airway pressure, peak and plateau airway pressures were documented every 5 minutesfor 25 minutes. The differences between the arterial and end-tidal carbon dioxide values were calculated. During the operation, peak airway pressures were found to be higher than control values in chronic smokers. Ainvay resistance was also higher than control values in this group and in non-smokers and the compliance was alsofound to be lower than baseline values (p<0.05). End-tidal and arterial carbon dioxide pressures were shown to increase in both groups (p<0.05). The differences between arterial and end-tidal carbon dioxide levels were significantly higher in chronic smokers when compared with baseline values and non-smokers (p<0.05). it was determined that low tidal volume-highfrequency ventilatory modes implemented with microlaryngeal tubes in chronic smokers resulted in high arterial - end-tidal carbon dioxide gradients and impaired ventilation significantly. We recommend monitoring arterial carbon dioxide levels in addition to end-tidal carbon dioxide levels and adjusting ventilator settings according to the needs of the patient rather than using pre-determined settings in smokers especially.

Keywords:

Airway Resistance, Smoking, Larynx, Laryngoscopy,

___

1. Muller KM, Krohn BR.Smoking habits and their relationship to precancerous lesions of the larynx. J Cancer Res Clin Oncol 1980; 96:211-7
2. Grasl MC, Neuwirth-Riedl K, Vtıtuc C, Horak F, Vorbeck F, Banyai M. Risk of vocal chord dysplasia in relation to smoking, alcohol intake and occupation. Eur J Epidemiol 1990 Man 6 :45-8
3. Danlon JV. Anesthesia and eye, ear, nose, and throat surgery. in: Miller RD, (ed) Anesthesia, New York, Churchill Livingston 1994;2175-95
4. Moon RE, Camporesi EM. Respiratory monitoring. In: Miller RD, (ed) Anesthesia, New York, Churchill Livingston 1994; 1253-89
5. Colo F, Girardis M, Pasqualueci A, Da Broi U, Pasetto A. Effeets of age, body vveight, and ventilatory pattern on the difference between arterial and end-tidal PCO2. Minerva Anestesiol 1994; 60: 367-74
6. Wahba RW, Tessler MJ. Misleading end-tidal CO2 tension. Can J Anaesth 1996; 43: 862-6
7. Feinstein R. Owens WD. Anesthesia for ear, nose, and throat surgery. in: Barash PG, Cullen BF. Stoelting RK, (eds) Clinical Anesthesia, Philadelphia, JB Lippincott Company 1995; 1113-24
8. Grenier B, Verchere E, Mesli A, et al. Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions. Anesth Anaig 1999; 88; 43-8
9. Hillen T, Sumpelmann R, Strauss JM. Intraoperalive changes in arterial end tidal CO2 partial pressure difference in interventions with constant ventilation-pertusion ratio. Anaesthesiol Reanim 1999; 24: 37-40
10. Frakes MA. Measuring End-tidal Carbon Dioxide: Clinical Applications and Usefulness. Critical Care Nurse 2001; 21: 23-35
11. Fletcher R. Smoking, age and the arterial-end-tidal PCO2, difference during anaesthesia and controlled ventilation. Acta Anaesthesiol Scand 1987; 31: 355-6
12. Fletcher R. Borris-Müller F. Can we improve the estimate of arterial PCO2 from end-tidal PCO2? Eur J Anaesth 2000; 17: 306-10
13. Capan LM, Ramanathan S. Sinha K, Turndorf H. Arterial to end-tidal CO2 gradients during spontaneous breathing, intermittent positive-pressure ventilation and jet ventilation. Crit Care Med 1985; 17:810-3
14. Fletcher R, Jonson B. Prediction of the physiological deadspace/tidal volume ratio during anaesthesia/IPPV from simple preoperative tests. Acta Anaesthesiol Scand 1981; 25: 58-62
15. Rodrigo C. The effeets of cigarette smoking on anesthesia. Anesth Prog 2000; 47:143-50.
16. From RP, Scamman FL. Ventilatory frequency influences accuracy of end-tidal CO2 measurements. Analysis of seven capnometers. Anesth Anatg 1988; 67: 884-6
17. Leatherman JW. Mechanical ventilation in obstuctive lung diseas. Clin Chest Med 1996; 17: 577-90
18. Beck G.I, Doyle CA, Schachter EN. Smoking and lung fuction. Am Rev Respir Dis. 1981; 123: 149-55