COVID-19 PANDEMİSİ’NİN ANESTEZİYOLOJİ VE REANİMASYON ASİSTANLARININ HAVAYOLU EĞİTİMİ VE PRATİĞİ ÜZERİNE ETKİSİ: BİR MANKEN ÇALIŞMASI

Amaç: Pandemi döneminde göreve başlayan tıpta uzmanlık öğrencilerinin (TUÖ) hem değişen pratik uygulamalar hem de değişen teorik eğitim nedeniyle eğitimlerinin belli bir sıra ve düzende yapılamaması kaynaklı olarak, havayoluna yaklaşım ve hava yolu yönetimlerinin normal dönemde gerekli bilgi ve beceriyi kazanmış eş kıdemde bir TUÖ göre yetersiz olacağı öngörülmüştür. Ana amaç manken üzerindeki uygulamalarda başarılı entübasyon oranları ve trakeal entübasyon denemelerinin sürelerinin karşılaştırılmasıdır Gereç ve Yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı’na, Türkiye’de ve hastanemizde pandemi önlemlerinin alındığı 11 Mart 2020’den önce başlayan 13 TUÖ ve 11 Mart 2020 ile yeniden normalleşmenin başladığı 1 Haziran 2020 tarihi arasında başlayan 12 tıpta uzmanlık öğrencisi (TUÖ)’nin farklı laringoskoplar ile entübasyon bilgi ve becerileri karşılaştırıldı. Pandemi Öncesi dönemde eğitime başlayan başlayan TUÖ’leri, pandemi öncesi dönemdeki çalışma süreleri pandemi sonrası dönemde başlayan TUÖ’lerine yakın olan “pandemi öncesi kıdemsiz” (n=6) ve daha uzun çalışma süresine sahip “pandemi öncesi kıdemli” (n=7) olarak ikiye ayrıldı. Her TUÖ’nin, anatomik olarak uygun bir manken üzerinde Macintosh, McCoy, Miller bleydler ve video laringoskop ile entübasyon gerçekleştirmesi istendi. Bulgular: Macintosh bleyd ile geçekleştirilen ilk entübasyon süreleri açısından gruplar arasında anlamlı farklılık vardı. Pandemi öncesi kıdemli grubunun süreleri en kısa saptandı. Video laringoskop ile kayıt edilen en kısa süreler de pandemi öncesi kıdemli grubunda saptandı, ancak gruplar arasında anlamlı farklılık yoktu. Sonuç: Pandemiye bağlı anestezi indüksiyonundaki değişikliklere bağlı olarak pandemiden sonra eğitime başlayan TUÖ için gelecekte hava yolu yönetimi konusu özel dikkat gerektirecektir.

The effect of COVID-19 pandemic on anesthesiology and reanimation residents’ airway training and practice: a mannequin study

Objective: We predicted that, due to the changing clinical practices and theoretical education, which gave rise to disturbances in the training program, the residents who started during the pandemic will be inadequate in terms of gaining the necessary knowledge and skills about airway approaches and airway management compared to residents with equivalent duration of residency who began before pandemic. The primary aim was to compare the successful endotracheal intubation rates and duration of tracheal intubation attempts on mannequin applications. Materials and Methods: The study included 13 residents (“pre pandemic” PreP) who started the residency training program before March 11th 2020 when the pandemic precautions were begun to be taken in our hospital and 12 residents (“post pandemic” PostP) who started between March 11th 2020 and June 6th 2020 when normalization has begun and compared their knowledge and skills on intubation with different laryngoscopes. The residents beginning training before the pandemic period were divided into two groups; those with short working period before the pandemic as “pre pandemic novice” (n=6) (PrePN) and those with longer working period as “pre pandemic senior” (n=7) (PrePS). Each resident was requested to intubate an anatomically accurate intubation mannequin with Macintosh, McCoy, and Miller blades and a video laryngoscope (VL). Results: The first attempt duration with the Macintosh blade was significantly different between all groups with PrePS having shorter durations. The shortest time for intubation completed with VL was also recorded for the PrePS group, though there were no significant differences. Conclusion: Changes in anesthesia induction practice due to the pandemic will require special attention to the topic of airway management in the future for residents beginning their training program after the pandemic.

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