Ayşe LAFCI, Derya GÖKÇINAR, SÜleyman CAMGÖZ, Serdar GÜNAYDIN

Kalp cerrahisi geçirmiş olan substernal guatr olgusunda zor entübasyon yönetimi

Redo tiroid cerrahisi çeşitli nedenlerle zor ve karmaşık olabilir. Bazı olgularda hava yolu yönetimi beklenmedik şekilde zorluklarla karşılaşılabilir. Bu durumda özel hava yolu cihazları gerekebilir. Biz bu olgu sunumunda, 67 yaşında, solunum sıkıntısı, öksürük ve yorgunluk yakınmaları olan tekrarlayan substernal guatr tanısı olan kadın hastayı sunduk. Bu olguda zor entübasyonu yönetmek için klasik laringeal maske hava yolu içine gum elastik buji yerleştirildi. Endotrakeal tüp yerleştirmeye kılavuz olması için gum elastik buji yerinde bırakılırken laringeal maske hava yolu çıkarıldı. Gum elastik buji üzerinden kaydırılarak endotrakeal tüp yerleştirildi. Zor entübasyon olgularında, laringeal maske hava yolu içinden yerleştirilen gum elastik buji ile endotrakeal entübasyon başarılabilir.

Anahtar Kelimeler:

Zor entübasyon, substernal guatr, laringeal maske havayolu, gum elastik buji

Management of difficult intubation in the case with substernal goiter underwent cardiac surgery

Redo thyroid surgery is difficult for several reasons and may be complicated. In some cases airway management can be more difficult unexpectedly. In this situation, special airway devices may be required. Here we present a case of a 67-year-old female patient who suffer from recurrent substernal goiter and has dyspnea, cough, and fatigue. In this case, difficult intubation was managed with a gum elastic bougie that was placed into the classical laryngeal mask airway. Laryngeal mask airway was removed while gum elastic bougie was left in place to guide endotracheal tube insertion. The endotracheal tube was slipped over gum elastic bougie. In cases of difficult intubation, endotracheal intubation can be achieved with the guidance of gum elastic bougie placed through the laryngeal mask airway.

Keywords:

Difficult intubation, substernal goiter, laryngeal mask airway, gum elastic bougie,

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1. Mobayen M, Baghi I, Farzan R, Talebi A, Maleknia SA, Paknejad SA. Comparison of the results of total thyroidectomy and Dunhill operation in surgical treatment of multinodular goiter. Indian J Surg 2015; 77: 1137-41.
2. Hsu B, Reeve TS, Guinea AI, Robinson, B, Delbridge, L. Recurrent substernal nodular goiter: incidence and management. Surgery 1996; 120: 1072-75.
3. Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988; 12: 449–53.
4. Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care 2002; 30: 48-51.
5. Brain AIJ. The laryngeal mask. A new consept in airway management. Br J Anaesth 1983; 55: 801.
6. van Zundert A, Al-Shaikh B, Brimacombe J, Koster J, Koning D, Mortier EP. Comparison of three disposable extraglottic airway devices in spontaneously breathing adults: the LMA-Unique, the Soft Seal laryngeal mask, and the Cobra perilaryngeal airway. Anaesthesiology 2006; 104: 1165-59.
7. Gill RK , Tarat A , Pathak D , Dutta S. Comparative study of two laryngeal mask airways: Proseal laryngeal mask airway and supreme laryngeal mask airway in anesthetized paralyzed adults undergoing elective surgery. Anesth Essays Res 2017; 11: 23-27.
8. Lukianov MV, Zolicheva Nlu. The use of the laryngeal mask in a female patient with an unpredictable difficult intubation. Anesteziol Reanimatol 1997; 4: 69-71.
9. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller’s Anesthesia. 8th ed. Philadelphia: Churchill Livingstone Elsevier 2015; 1661-64.
10. Wong DT, Yang JJ, Mak HY, Jagannathan N. Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review. Can J Anaesth 2012; 59: 704-15.