Yusuf İPEK, Zeynep BAYSAL, Enes ÇELİK, Hakan AKELMA

LUMBAR DİSK HERNİSİ OPERASYONLARININ ENDOTRAKEAL KAF BASINCINA VE TRAKEAL MORBİDİTEYE ETKİSİ

Amaç: Endotrakeal tüplerin kafları yüksek basınçla şişirildiğinde ciddi anlamda morbiditeler ile karşılaşılır. Çalışmamızın amacı farklı pozisyonlarda değişebilen endotrakeal tüp kaf basıncının operasyon süresince değerlerini takip edilmesi ve trakeal morbiditeye etkilerinin araştırılmasıdır. Materyal ve method: Prospektif gözlemsel çalışma.Çalışmaya endotrakeal entübasyon ile genel anestezi uygulanan yaşları; 18-80 arasında olan, ASA 1-2 grubunda, Mallampati sınıf 1-2 ye giren rastgele seçilmiş 60 hasta dahil edildi. Lomber disk hernisi operasyonu olan 30 hasta prone pozisyonunda grup 1, alt veya üst ekstremite cerrahisi olan 30 hasta supine pozisyonunda grup 2 olmak üzere 2 gruba ayrıldı. Tüm hastalara standart genel anestezi uygulandı. Her iki gruptaki hastalar supine pozisyonunda entübe edildikten sonra endotrakeal kaf manometresi ile 28-30 cmH2O arasında olacak şekilde pilot balon şişirildi. Endotrakeal tüp kaf basıncı tüm operasyon süresi boyunca sürekli olarak takip edildi ve her 5 dk’da bir kayıt altına alındı. Hastalar postoperatif 1, 8 ve 24. saatte öksürük, disfoni ve boğaz ağrısı açısından değerlendirildi. Bulgular: Grupların hemodinamik ve solunumsal parametreleri, sıcaklık değerleri operasyon süresince kaydedildi. Kaf basınçları, postoperatif öksürük, ses kısıklığı ve boğaz ağrısı grup 1 de istatistiksel olarak anlamlı yüksek görüldü (p:0,0001). Sonuç: Endotrakeal entübasyona bağlı gelişebilecek trakeal morbidite ve buna bağlı komplikasyonları en aza indirebilmek için kaf basınç monitorizasyonun standart haline gelmesi özellikle prone pozisyonundaki operasyonlarda sürekli ölçüm gerektiği sonucuna varıldı.

Anahtar Kelimeler:

Prone pozisyonu, Endotrakeal entübasyon, Lomber disk hernisi, Boğaz ağrısı, Trakeal hastalıklar

The Effect of Lumbar Disc Hernia Operations in Prone Position on Endotracheal Cuff Pressure and Tracheal Morbidity

Background: When the cuffs of endotracheal tubes are inflated with high pressure, serious morbidities are encountered. The aim of our study is to monitor the values of endotracheal tube cuff pressure, which can change in different positions, during the operation and to investigate its effects on tracheal morbidity. Materials and Methods: Prospective observational study. The age at which general anesthesia with endotracheal intubation was applied to the study; Sixty randomly selected patients in the ASA 1-2 group, 18-80 years old, and Mallampati class 1-2 were included between July 2016 and July 2017. Thirty patients with lumbar disc herniation surgery were divided into 2 groups as group 1 in the prone position, and group 2 in the supine position of 30 patients with lower or upper extremity surgery. After the patients in both groups were intubated in the supine position, the pilot balloon was inflated with an endotracheal cuff manometer between 28-30 cmH2O. Endotracheal tube cuff pressure was continuously monitored throughout the entire operation and recorded every 5 minutes. The patients were evaluated in terms of cough, dysphonia and sore throat at 1, 8 and 24 hours postoperatively. Results: Hemodynamic and respiratory parameters and temperature values of the groups were recorded during the operation. Cuff pressures, postoperative cough, hoarseness and sore throat were statistically significantly higher in group 1 (p:0.0001). Conclusion: In order to minimize tracheal morbidity and related complications that may develop due to endotracheal intubation, it was concluded that cuff pressure monitoring should become standard and continuous measurement is required, especially in operations in the prone position.

Keywords:

Endotracheal intubation, Lumbar disc herniation, Prone position, Sore throat, Tracheal diseases,

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