İsa URAN, Selcan YEREBAKAN, Elif MOĞOL, Hülya BİLGİN, Fatma Nur KAYA

Laringeal Mask Airway Kullanımı ile İlgili Komplikasyonların Prospektif Olarak Değerlendirilmesi

'Laringeal maske airway' (LMA) uygulamasına bağlı faringolaringeal komplikasyonlar gelişebilmektedir. Çalışmamızda genel anestezi altında LMA kullanılan hastalarda, LMA uygulmasına bağlı komplikasyonları prospektif olarak incelemeyi amaçladık. Ekim 2015-Mayıs 2016 tarihleri arasında opere olacak ve LMA kullanılacak 'American Society of Anesthesiologists' skoru (ASA) I-III olan 18 yaş ve üzeri hastalar çalışmaya dahil edildi. Hastaların demografik özellikleri, operasyon süresi, operasyon öyküleri, intraoperatif hemodinamik parametreleri, oksijen saturasyonu, LMA’nın kaf basıncı, LMA’yı yerleştiren sağlık personelinin görevi ve deneyimi, deneme sayısı kaydedildi. LMA uygulamasına bağlı gelişen ventilasyon problemi, hıçkırma, hava yolu reaksiyonu gibi komplikasyonlar; mukoza hasarı, kanama gibi intraoperatif komplikasyonlar ve regürjitasyon, bronkolarengeal spazm, ses kısıklığı, yutma güçlüğü gibi postoperatif komplikasyonlar ile LMA çıkartıldıktan sonra üzerindeki kan varlığı da not edildi. Komplikasyon olan ve olmayan grup arasında, yaş arttıkça komplikasyon görülme sıklığı artmış (p=0.009), ASA I hastalarda daha az komplikasyon görülmüştür (p=0.001). Bir yıldan az deneyimi olan sağlık personelinde, 4 yıldan fazla deneyimi olanlara göre daha fazla komplikasyon saptanmıştır (p=0.003). Doktorlar tarafından LMA yerleştirildiğinde daha fazla komplikasyon görülmüştür (p=0.003). Komplikasyonların çoğunluğu LMA yerleştirilirken meydana gelmiştir (p=0.001). Son bir hafta içerisinde genel anestezi altında entübe edilmiş (p=0.002) veya LMA yerleştirilmiş hastalarda (p=0.024) veya ekstübasyon sonrası LMA üzerinde kan görülenlerde komplikasyon oranı daha fazla bulunmuştur (p=0.001). Komplikasyonlar operasyon süresi 30-60 dk arasında olanlarda daha fazla (p=0.04), 15 dk.dan az olanlarda daha az görülmüştür (p=0.01). Sonuç olarak, 3 saatin altında uygun operasyonlarda ve deneyimli uygulayıcı eşliğinde hasta ve uygulayıcı lehine birçok avantaja sahip olduğunu bildiğimiz LMA kullanımına bağlı komplikasyonların; deneyimin artırılması ve girişim sayısının az tutulması ile en aza indirilebileceği kanısına vardık.

Anahtar Kelimeler:

laringeal mask airway, genel anestezi, komplikasyon

Prospective Evaluation of Complications Related to the Use of Laryngeal Mask Airway

The use of ‘laryngeal mask airway' (LMA) can lead to pharyngolaryngeal complications. We aimed to prospectively analyze complications in patients who had LMA as an airway device under general anesthesia. American Society of Anesthesiologists score (ASA) I-III class patients, who were over 18 years and administered LMA between October 2015 and May 2016 were enrolled into the study. Patients’ demographic characteristics, duration of operation, operation history, intraoperative hemodynamic parameters, oxygen saturation, cuff pressure of LMA, experience level and situation of healthcare personnel and the number of attempts were recorded. Additionally, we noted intraoperative complications and complications during insertion and removal of LMA and presence of blood stain on LMA after removal. The incidence of LMA-associated complications increased with age (p=0.009). The rate of complications was lower in ASA I class patients (p=0.001). The rate of complications was higher when LMA was placed by a physician (p=0.003). Complications was higher in unexperienced medical staff to over 4 years experienced ones (p=0.010). Majority of complications occurred while inserting LMA (p=0.001). Furthermore, the rate of complications was higher among the patients, who were intubated (p=0.002) or intervened with LMA (p=0.024) for general anesthesia in the last one week. We observed more complications in patients, whose LMA was bloody after removal (p=0.001). Additionally, the rate of complications was higher among patients whose operation duration was between 30-60 minutes (p=0.04), it was lower in patients who were under operation for less than ≤15 minutes (p=0.01). As a result, complications related to LMA use, which we know to have many advantages in favor of the patient and the practitioner in appropriate operations under 3 hours and in the company of experienced practitioners; we concluded that it can be minimized by increasing the experience and keeping the number of initiatives low.

Keywords:

LMA, Complications, General Anesthesia,

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