Namık ÖZCAN, Mustafa KOTANOĞLU, Hülya BAŞAR, Melih TARHAN, Yusuf HATIL, Fatih GENECİ, Çetin KAYMAK, Bülent BALTACI

ZOR ENTÜBASYON OLGULARINDA TRUVIEW, MC GRATH VİDEO VE KONVANSİYONEL LARİNGOSKOPİ KULLANIMLARININ KARŞILAŞTIRILMASI

AMAÇ: Zor entübasyon, anestezi pratiğinde hasta hayatını tehdit edecek boyuta gelebilen potansiyel bir problemdir. Zor hava yolu ile karşılaşıldığında, alternatif yöntemlerin de uygulanabiliyor olması, zor entübasyon olgularında başarılı hava yolu yönetimi şansını arttıracaktır. Bu çalışmada servikal collar ile ekstansiyon kısıtlılığı yaratılarak, zor entübasyon şartları oluşturulmuş ve Truview, Mc Grath, Macintosh laringoskop ile, deneme sayısı, laringeal görüntüleme ve entübasyon sürelerinin karşılaştırılması amaçlanmıştır.GEREÇ VE YÖNTEM: Çalışma, genel anestezi altında elektif cerrahi geçirecek ASA I-II toplam 45 hastada planlandı. Her grup için 15 hasta değerlendirmeye alındı. Tüm hastalara servikal collar takılarak boyun ekstansiyonunda sınırlama oluşturuldu ve zor entübasyon şartları sağlanmaya çalışıldı. Hastalara 3 dk preoksijenasyondan sonra, anestezi indüksiyonunda 2mg/kg propofol, 1µg/kg fentanyl ve 0.6mg/kg rokuronyum kullanıldı. Birinci gruptaki hastalar Macintosh laringoskop kullanılarak entübe edildi. İkinci gruptaki hastalar Truview, üçüncü gruptaki hastalar Mc Grath video laringoskop yardımıyla entübe edildi. Erkek hastalar için 8-8.5 bayan hastalar için 7-7.5 endotrakeal tüp kullanıldı. Entübasyon zamanı; hastanın ağzına yardımcı entübasyon aletinin girmesi ile entübasyonun kapnografi ile doğrulanması arasındaki süre olarak kabul edildi. Ayrıca entübasyon deneme sayısı, laringeal görüntüleme değerleri (Cormack-Lehane, CL) not edildi. Verilerin istatistiksel analizinde, gruplar arası değerlendirmede Kruskal Wallis ve Anova testleri, niceliksel verilerin karşılaştırılmasında Chi-Square testi kullanıldı. P

THE COMPARATION OF USING THE TRUVIEW, MC GRATH VIDEO AND CONVENTIONAL LARYNGOSCOPE ON DIFFICULTY AIRWAY CASES

OBJECTIVE: Difficult intubation is a potential problem in anesthesia practice that can threat the patients life. In management of difficult airway, avaibility of alternative methods will increase the success. In this study difficult intubation model was established with a cervical collar limiting cervical extension. We aimed to compare the number of attempts, laryngeal visualization and intubation times between Trueview, Mc Grath and Macintosh laringoscopes. MATERIALS AND METHODS: Fourty-five ASA I-II patients undergoing elective surgery under general anesthesia were included in the study. Fifteen patients for each group was enrolled. Difficult intubation model was established with a cervical collar limiting cervical extension in all patients. Following 3 minutes of preoxygenation, anesthesia was induced with 2 mg/kg propofol, 1µg/kg fentanyl and 0.6mg/kg rocuronium. Macintosh laryngoscope was used for the tracheal intubation of patients in Group 1. The trachea was intubated using Truview and Mc Grath video laryngoscopes in Group 2 and 3, respectively. Endotracheal tube size was chosen as 8-8.5 F for male and 7-7.5 F for female patients. Time for intubation was accepted as the time between entrance of the laryngoscope into the patients' mouth and confirmation of intubation on capnograph. The number of intubation attempts and laryngeal visualization scores (Cormack-Lehane, CL) were also recorded. Comparison between groups were performed by Kruskal Wallis and Anova tests, quantitative data were compared by Chi-square test. P

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1) Tomas J. Galt T.J, Airway Management. In Miller RD ed. Anesthesia. 6th ed. Churchill Livingstone Philadelphia, 2005;1631-4.
2) An Update Report by The ASA Task Force on Management of Difficult Airway. Anesthesiology 2003; 98: 1269- 77.
3) B. Shippey, D. Ray, D. McKeown. Use of the McGrathw videolaryngoscope in the management of difficult and failed tracheal intubation. British Journal of Anaesthesia 2008;100 : 116-9.
4) Goyagi T, Nishikawa T. Comparative performance of Airway Scope, Trueview EVO2, and Fibertech video laryngoscope used by inexperienced medical students in a simulated manikin with normal and difficult airways, .Masui 2013, 62:109-15.
5) Macintosh, R.R. new laryngoscope. Lancet 1943; 241:205.
6) Shıga T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.Anesthesiology 2005; 103:429-37.
7) Cavus, E., Kieckhaefer, J., Doerges, V., Moeller, T., Thee, C., Wagner, K., 2010. The C-MAC videolaryngoscope: first experiences with a new device for videolaryngoscopy-guided intubation. Anesth, Analg. 110, 473-7.
8) Enomoto, T., Asai, T., Arai, T., Kamishima, K., Okuda, Y. Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements Br. J. Anaesth, 2008: 100; 544-8.
9) Miceli, L., Cecconi, M., Tripi, G., Zauli, M., Della, Rocca, G. Evaluation of new laryngoscope blade for tracheal intubation, TruviewEVO2: a manikin study Eur. J. Anaesth. 2008: 25, 446-9.
10) Malik, M.A., Maharaj, C.H., Harte, B.H., Laffey, J.G. Comparison of Macintosh, Truview EVO', GlideScope and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br. J. Anaesth. 2008:101;723-30.
11) Maruyama, K.,Yamada. T., Kawakami, R., Hara, K. Randomized cross-over comparison of cervical-spine motion with the AirWayScope or Macintosh laryngoscope with in-line stabilization: a video-fluoroscopic study. Br. J. Anaesth. 2008: 101; 563-7.
12) Alanoğlu Z, Selvi Can O, Alver F, Ökten F, Özatamer O. Use Of Truview EVO2 Optical Laryngoscope System In Anticipated Difficult Airway Situation. ESAPOSTER 3.Fh9
13) Pratice Guidelines for management of the Difficult Airway. An Update Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 1-20.