SÜHEYLA KARADAĞ ERKOÇ, Özlem Selvi CAN, ÇİĞDEM YILDIRIM GÜÇLÜ, Yeşim BATİSLAM

LMA-FASTTRACH İLE KÖR ENTÜBASYONDA FİBEROPTİK BRONKOSKOPİK GÖRÜNTÜLEME ENTÜBASYON BAŞARISI İÇİN GEREKLİ Mİ?

Giriş: LMA-Fastrach™ (LMA-FT) hem tahmin edilmeyen, hem öngörülebilen zor entübasyonlarda ve diğer tekniklerle birlikte başarısız entübasyonlarda kullanılmak üzere tasarlanmıştır. Bu çalışmada LMA-FT yerleştirilmesi ile elde edilen fiberoptik bronkoskop (FOB) görüntüsü skorlanarak, FOB yardımı olmadan LMA-FT içinden kör entübasyon yapılarak; bronkoskop görüntüsüne ait skorlar ile kör entübasyon başarısı arasında bir korelasyon olup olmadığı araştırıldı. Gereç ve yöntem: Çalışmaya elektif cerrahi geçiren ve endotrakeal entübasyon gerektiren, ASA I-III, 18-80 yaş arası 100 hasta dahil edildi. Mallampati skoru (MS), Tiromental mesafe (TMM), Sternomental mesafe (SMM), Ağız açıklığı (AA), Üst dudak ısırma testi (UDIT) değerlendirildi. Preoperatif standart monitorizasyon uygulandıktan ve intravenöz ilaçlarla anestezi indüksiyonu yapıldıktan sonra direkt laringoskopi yapılarak Cormack-Lehane skoru değerlendirildi. LMA-FT yerleştirildikten sonra deneyimli bir anestezist tarafından FOB aracılığıyla vokal kordların konumu değerlendirildi ve Brimacombe sınıflaması kullanılarak skorlandı. Hastalar LMA-FT içinden endotrakeal tüp (ETT) ile kör entübe edildi. Entübasyondan sonra LMA-FT çıkarıldı. FOB görüntüleme skorları, LMA-FT yerleştirilmesi ve trakeal entübasyonda başarı oranları, başarılı ventilasyon ve trakeal entübasyon için gerekli deneme sayıları ve süreleri, işlem ile ilişkili komplikasyonlar kaydedildi. Bulgular: Çalışmamızda 100 hastada LMA-FT ile kör entübasyon, hastaların % 81’inde ilk denemede, % 12’sinde ikince denemede olmak üzere toplam 93 (%93) hastada başarılı oldu. 7 hastada iki kez deneme sonucunda entübasyon başarısız oldu. Brimacombe skorları ile entübasyon başarısı arasında korelasyon olduğu bulundu (p=0.001). Entübasyon başarısı ile zor entübasyon kriterleri arasında anlamlı farklılık bulunmadı. Sonuç: LMA-FT ile kör entübasyon başarısı göreceli olarak yüksek bulundu. Başlangıçta fiberoptik bronkoskopik değerlendirmeyle, LMA-FTile zor entübasyon olacağının tahmin edilebileceği sonucuna varıldı.

IS FIBEROPTIC BRONCHOSCOPIC IMAGING REQUIRED FOR SUCCESS WITH BLIND INTUBATION VIA LMA-FASTRACH ?

Introduction: LMA-Fastrach™ (LMA-FT) is a designed for use in both anticipated and unexpected difficult intubations, and for failed intubations with other techniques. In this study fiberoptic bronchoscope (FOB) imaging through LMA-FT scored and blind intubation via LMA–FTwas performed. Correlation between scores and success of blind intubation was investigated. Patients and Methods: One hundred ASA1-3 patients aged between 18-80 years, who required endotracheal intubation were scheduled for elective surgery. Mallampati scoring, Thyromental and sternomental distance, upper lip bite test were recorded. After standard monitoring and intravenous induction including neuromusculer blocker direct laryngoscopy was performed for Cormack-Lehane score evaluation. LMA-FT was inserted and view of vocal cords was evaluated by an experienced anesthetist via FOB and scored by using Brimacombe classification. After FOB scoring, blind intubation through LMA-FT with endotracheal tube was applied to all patients, and LMA-FT was removed after intubation. FOB scores, times for successful placement of the LMA-FT and tracheal intubation, number of attempts needed for successful ventilation and tracheal intubation, and complications associated with the procedure were recorded. Results: Blind tracheal intubation through LMA-FT was successful in 81% of the cases at the first attempt and 12% at the second attempt. The tracheal intubation of 7% of the patients failed after the two attempts. There was a significant correlation between succesful intubation and Brimacombe scores (p=0.001). There was no significant difference between intubation success and other difficult intubation criteria. Conclusion: Success rate of blind intubation through LMA-FT was founded relatively high. It has been concluded that difficult intubation via LMA-FTcan be predicted by initially doing a fiberoptic bronchoscopic evaluation.

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