PEDİYATRİK ŞAŞILIK CERRAHİSİNDE ENDOTRAKEAL TÜP İLE FLEKSİBL LARİNGEAL MASKENİN POSTOPERATİF KOMPLİKASYONLAR VE AJİTASYON ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI
Amaç: Genel anestezi uygulamalar› s›ras›nda havayolu güvenli¤inin sa¤lanmas› amac›yla çeflitli araçlar kullan›lmaktad›r. Fleksibl laringeal maske (FLMA) bafl ve boyun cerrahisinde kullan›labilmesi, cerrahi sahadan uzaklafl›rken yerinden kayma riskini minimalize edebilmesi gibi avantajlar sa¤lar. Bu çal›flmada flafl›l›k cerrahisi planlanan pediyatrik hastalarda endotrakeal entübasyon ile FLMA’n›n postoperatif dönemde görülebilen komplikasyonlar ve ajitasyon üzerine etkilerinin karfl›laflt›r›lmas› amaçland›. Yöntem: Çal›flma, Mersin Üniversitesi T›p Fakültesi Bilimsel Araflt›rmalar› De¤erlendirme Komisyonu’ndan onay al›nd›ktan sonra, genel anestezi alt›nda flafl›l›k cerrahisi planlanan, ASA I-II, 0–16 yafl aral›¤›nda, toplam 84 hasta üzerinde yap›ld›. Grup ETT ’de (n=43) hastalara ETT, grup FLMA’da (n=41) ise FLMA yerlefltirildi. Olgular›n demografik verileri, operasyon özellikleri, havayolu araçlar›n› yerlefltirme süreleri ve giriflim say›lar›, hemodinamik ve solunumsal parametreler preoperatif, entübasyon öncesi, entübasyon sonras›, peroperatif 5. 10. 15. 30. 45. 60. dk’larda kaydedildi. Postoperatif dönemdeki komplikasyonlar (bulant›-kusma, laringospazm, bronkospazm, yutma güçlü¤ü ve ses k›s›kl›¤›), a¤r› (cerrahi alan ve bo¤az) ve ajitasyon ise 15.dk, 1. ve 4. saatlerde de¤erlendirildi. Bulgular: Yap›lan ölçümlerde demografik veriler, operasyon özellikleri, hemodinamik ve solunumsal parametreler her iki gruptada benzer bulundu (p>0.05). Havayolu gereçlerinin yerlefltirme süreleri Grup FLMA da Grup ETT’ye göre anlaml› derecede düflük idi (p=0.02). Postoperatif komplikasyonlar›n de¤erlendirilmesinde; ekstübasyon sonras› laringospazm görülme s›kl›¤› Grup ETT’de Grup FLMA’ya göre istatistiksel olarak anlaml› derecede yüksek idi (p=0.019). Postoperatif bo¤az a¤r›s› 15.dk ve 4. saatte Grup ETT’de, Grup FLMA’ya göre anlaml› derecede yüksek saptand› (p=0.042, p=0.004). Hastalarda postoperatif 15.dk, 1. ve 4. saatteki yutma güçlü¤ü ve ses k›s›kl›¤› aç›s›ndan gruplar aras›nda istatistiksel olarak fark bulunmad› (p>0.05). Ajitasyon skoru Grup ETT’de Grup FLMA’ya göre istatistiksel olarak anlaml› derecede yüksek idi (p=0.029). Sonuç: FLMA’n›n endotrakeal entübasyona göre daha az komplikasyon ve postoperatif ajitasyona neden oldu¤u, klinik olarak FLMA uygulamas›n›n etkili güvenli bir flekilde kullan›labilece¤i kan›s›na var›ld›.
COMPARISON OF THE EFFECTS OF ENDOTRACHEAL INTUBATION AND FLEXIBLE LARYNGEAL MASK ON POSTOPERATIVE COMPLICATIONS AND AGITATION IN PEDIATRIC STRABISMUS SURGERY
Objective: During general anesthesia procedures, various devices are used for ensuring airway safety. Using flexible laryngeal mask airway (FLMA) in head and neck surgery provides advantages such as minimizing the risk of slipping from its location while keeping distance from the surgical field. In this study, our aim was to compare the effects of endotracheal tube and FLMA on postoperative complications and agitation in pediatric patients who were scheduled for strabismus surgery. Method: Following the approval obtained from Research Assessment Commission of Mersin University Medical Faculty, the study was conducted on a total of 84 patients, aged between 0-16 years and ASA I-II, scheduled for strabismus surgery under general anesthesia. In Group ETT (n=43), endotracheal tube (ETT) was placed and in Group FLMA (n=41), FLMA was placed. The demographic data of the patients, features of the operation, duration and number of attempts for insertion of the airway device and the hemodynamic and respiratory parameters measured preoperatively, before intubation, after intubation, perioperatively at 5 th , 10 th , 15 th , 30 th , 45 th , and 60 th minutes were recorded. Complications in the postoperative period (nausea, vomiting, laryngospasm, bronchospasm, dysphagia and hoarseness), pain (surgical field and throat) and agita- tion were assessed at 15 th minute, 1 st hour and 4 th hour. Results: The demographic data, features of the operations performed, hemodynamic and respiratory parameters were found similar in both groups (p>0.05). Duration for insertion of airway equipment was significantly less in Group FLMA when compared to Group ETT (p=0.02). Regarding postoperative complications; the incidence of post-extubation laryngospasm was statistically significantly higher in Group ETT, when compared to Group FLMA (p=0.019). Incidence of postoperative sore throat was found to be significantly higher in Group ETT than in Group FLMA (p=0.042, p=0.004) at 15 th minute and 4 th hour. There were no statistically significant differences between groups in terms of dysphagia and hoarseness at postoperative 15 th minute, 1 st hour and 4 th hour (p>0.05). Agitation score of Group ETT was statistically significantly higher than the score of Group FLMA (p=0.029). Conclusion: We suggest that FLMA causes fewer complications and less postoperative agitation when compared to endotracheal intubation and FLMA application can clinically be used effectively and safely.
___
- Ecoffey C. Laryngeal mask airway in pediatrics: When? How?
Ann Fr Anesth Reanim 2003; 22: 648-652.
- Brimacombe J, Keller C. Comparison of the flexible and Standard
laryngeal mask airways. Can J Anesth 1999; 46: 558-563.
- Keller C, Brimacombe J. The influence of head and neck position
on oropharyngeal leak pressure and cuff position with the flexible
and the standard laryngeal mask airway. Anesth Analg 1999; 88:
913-916.
- Ifl›k B, Arslan M, Do¤an AT, Kurtipek Ö. Farkl› Zamanlarda
Uygulanan Fentanilin Derlenme Ajitasyonu Üzerine Etkisi. Türk
Anest Rean Der Dergisi 2005; 33: 311-317.
- Aouad MT, Nasr VG. Emergence agitation in children: an update.
Curr Opin Anaesthesiol 2005; 18: 614-619.
- Jung HJ, Kim JB, Im KS, Oh SH, Lee JM. Effect of ketamine
versus thiopental sodium anesthetic induction and a small dose of
fentanyl on emergence agitation after sevoflurane anesthesia in
children undergoing brief ophthalmic surgery. Korean J Anesthesiol
2010; 58: 148-152.
- Bae JH, Koo BW, Kim SJ, Lee DH, Kang CJ. The effects of
midazolam administered postoperatively on emergence agitation
in pediatric strabismus surgery. Korean J Anesthesiol 2010; 58:
45-49.
- Webster AC, Morley-Forster PK, Janzen V, et al. Anesthesia for
intranasal surgery: a comparison between tracheal intubation and
the flexible reinforced laryngeal mask airway. Anesth Analg 1999;
88: 421-425.
- Webster AC, Doin S, Ganapathy S, Ruby R. Anaesthesia for
adenotonsillectomy: a comparison between tracheal intubation
and the armoured laryngeal mask airway. Can J Anesth 1993; 40:
1171-1177.
- Nanji GM, Maltby JR. Vomiting and aspiration pneumonitis with
the laryngeal mask airway. Can J Anaesth 1992; 39: 69-70.
- Pearce AW, Heath ML. Aspiration pneumonia and the laryngeal
mask airway. Anaesthesia 1991; 46: 592.
- Barker P, Langton JA, Murphy PJ, Rowbottam DJ. Regurgitation
of gastric contents during general anaesthesia using the laryngeal
mask airway. Br J Anaesth 1992; 69: 314-315.
- Mikatti NE, Luthra AD, Healy TEJ, Mortimer AJ. Gastric
regurgitation during general anaesthesia in the supine position
with the laryngeal and face mask airways. Abstracts. Proceedings
of the Anaesthetic Research Society, Leicester Meeting, July
10-11, 199 Br J Anaesth 1992; 69: 529P-530P.
- Joshi GP, Inagaki Y, White PF et al. Use of the laryngeal mask
airway as an alternative to the tracheal tube during ambulatory
anesthesia Anesth Analg 1997; 85: 573-577.
- Balkan K, Günenç F, Iyilikçi L, Gökel E. The laryngeal mask
airway (LMATM) in paediatric ophthalmic anaesthesia practice.
European Journal of Anaesthesiology 2005; 22: 67-79.
- Jamil SN, Alam M, Usmani H. Khan MM. A study of the use of
laryngeal mask airway in children and its comparison with
endotracheal intubation. Indian J Anaesth 2009; 53: 174-178.
- Ates Y, Alanoglu Z, Uysalel A. Use of the laryngeal mask airway
during ophthalmic surgery results in stable circulation and few
complications: a prospective audit. Acta Anaesthesiol Scand
1998; 42: 1180-1183.
- Higgins PP, Chung F, Mezei G. Postoperative sore throat after
ambulatory surgery. Br J Anaesth 2002; 88: 582-584.
- Mizutamari E, Yano T, Ushij›ma K, Ito A. A comparison of
postoperative sore throat after use of laryngeal mask airway and
tracheal tube. J Anesth 2004; 18: 151-157.
- Manworren CL, Paulos R. Treating children for acute agitation in
the PACU: Differentiating pain and emergence delirium. Journal
of PeriAnesthesia Nurs 2004; 19; 183-193.
- Voepel-Lewis T, Malviya S, Tait AR. A Prospective cohort study
of emergence agitation in the pediatric postanesthesia care unit.
Anesth Analg 2003; 96: 1625-1630.