Ayten SARACOGLU, Kemal SARACOGLU, Ferhat ERENLER, Hüseyin CANAZ, Deniz KIZILAY, İbrahim Haluk KAFALI

The Evaluation of Difficult Intubation Risk in Children with Hydrocephalus Undergoing Shunt Surgery: A Prospective Controlled Study

INTRODUCTION: Hydrocephalus commonly cause serious challenges in airway management of newborn and paediatric patients, leading to enlarged head and distortion of skull anatomy. This result in difficulty for conventional laryngoscopy by hindering positioning of head. In this study, we aimed to determine the relationship between anatomic features and the signs of difficult intubation in paediatric patients undergoing shunt surgery. METHODS: Sixty patients requiring ventriculoperitoneal shunt insertion were enrolled. Patients divided into three groups based on >1 month of age with hydrocephalus (n=20), newborn with hydrocephalus (n=20) and newborn without hydrocephalus (n=20). Head circumference, the lower and upper lip-chin distance, sternomental and thyromental distance, Cormack-Lehane Classification scores were recorded. The number of attempts for successful intubation, presence of optimization maneuvers were also recorded. The difficulty of intubation was evaluated with a 10 cm VAS ruler. All patients were intubated by the same anaesthesiologist. RESULTS: The ASA scores, number of intubation attempts, and the frequency of optimization maneuvers were significantly lower in neonates without hydrocephalus as compared to patients with hydrocephalus (p˂0.05). The tragus-to-chin distance was decreased in the neonates with hydrocephalus in comparison with those without hydrocephalus. The CormackLehane grade III was significantly increased while the Cormack-Lehane grade I was significantly decreased in neonates with hydrocephalus (p

Şant Cerrahisi Geçiren Hidrosefalili Çocuklarda Zor Entübasyon Riskinin Değerlendirilmesi: Bir Prospektif Kontrollü Çalışma

GİRİŞ ve AMAÇ: Hidrosefali kafa kaidesinde genişlemeye ve kafatasının anatomisinin bozulmasına öncülük ederek genellikle yenidoğan ve pediatrik hastaların havayolu yönetiminde ciddi zorluklara neden olmaktadır. Bu, başın yerleşmesini engelleyerek geleneksel laringoskopi için zorlukla sonuçlanır. Bu çalışmada şant cerrahisi geçiren pediyatrik hastalarda anatomik özellikler ile zor entübasyon bulguları arasındaki ilişkiyi belirlemeyi amaçladık. YÖNTEM ve GEREÇLER: Ventriküloperitoneal şant yerleştirilmesi gerektiren altmış hasta çalışmaya alındı. Hastalar üç gruba ayrıldı: hidrosefalisi olan >1 ay üzerinde (n=20), hidrosefalisi olan yenidoğan (n=20) ve hidrosefalisi olmayan yenidoğan (n=20). Baş çevresi, alt ve üst dudak-çene mesafesi, sternomental ve tiromental mesafe, Cormack-Lehane sınıflaması skoru kaydedildi. Başarılı entübasyon için girişim sayısı, optimizasyon manevralarının varlığı da kaydedildi. Entübasyonun zorluğu 10 cm’lik VAS cetveliyle ölçüldü. Tüm hastalar aynı anesteziyolojist tarafından entübe edildi. BULGULAR: ASA skorları, entübasyon girişim sayıları, optimizasyon manevralarının sıklığı, hidrosefalisi olanlarla karşılaştırıldığında hidrosefalisi olmayan yenidoğanlarda anlamlı olarak daha düşüktü (p˂0,05). Hidrosefalisi olmayanlarla karşılaştırıldığında tragus-çene mesafesi hidrosefalisi olan yenidoğanlarda azalmıştı. Hidrosefalisi olan yenidoğanlarda Cormack-Lehane sınıf III anlamlı olarak artmışken, Cormack-Lehane sınıf I anlamlı olarak azalmıştır (p

PDF

___

1. Krishnamurthy S, Li J. New concepts in the pathogenesis of hydrocephalus. Transl Pediatr 2014; 3: 185-94.

2. Zahl SM, Egge A, Helseth E, Wester K. Benign external hydrocephalus: a review, with emphasis on management. Neurosurg Rev 2011; 34: 417-32.

3. Norkett W, McLone DG, Bowman R. Current Management Strategies of Hydrocephalus in the Child With Open Spina Bifida. Top Spinal Cord Inj Rehabil 2016; 22: 241-6.

4. Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS 2012; 9: 18.

5. Akçıl EF, Dilmen ÖK, Tunalı Y. Anaesthetic Management in Costello Syndrome. Turk J Anaesthesiol Reanim 2015; 43: 427-30.

6. Malinzak EB, Taicher BM. Anesthetic consideration for congenital hydrocephalus. Pediatric Anesthesia and Critical Care Journal 2015; 3: 10-4.

7. Vagyannavar R, Bharti V, Hashim M. Difficult airway in a case of gross hydrocephalus for shunt surgery. Anesth Essays Res 2017; 11: 1109- 11.

8. 8.Hamid RK, Newfield P. Pediatric neuroanesthesia. Hydrocephalus. Anesthesiol Clin North America 2001; 19: 207-18.

9. Rissler J, Gudmundsson A, Nicklasson H, Swietlicki E, Wollmer P, Löndahl J. Deposition efficiency of inhaled particles (15-5000 nm) related to breathing pattern and lung function: an experimental study in healthy children and adults. Part Fibre Toxicol 2017; 14: 10.

10. Saracoglu KT, Saracoglu A, Kafali H. Basic airway equipments in pediatric cardiac arrest management. Trends in Anesthesia and Critical Care 2016 June;7-8:54-58.

11. Holm-Knudsen RJ, Rasmussen LS. Paediatric airway management: basic aspects. Acta Anaesthesiol Scand 2009; 53: 1-9.

12. Ghodki P. Extremely huge hydrocephalus for surgery: Difficult intubation made easy! Journal of Anaesthesia and Critical Care Case Reports 2017; 3: 41-2.

13. Vagyannavar R, Bharti V, Hashim M. Difficult Airway in a Case of Gross Hydrocephalus for Shunt Surgery. Anesthesia, Essays and Researches 2017; 11: 1109-11.

14. Mahajan C, Rath GP, Bithal PK, Mahapatra AK. Perioperative Management of Children With Giant Encephalocele: A Clinical Report of 29 Cases. J Neurosurg Anesthesiol 2017; 29: 322-9.